Breast augmentation - what is the risk of bottoming out if I get implants? (Photo)

Your previous breast lift was inadequate as the breasts are still low on the chest wall and you lack upper pole fullness. The technique I recommend is a breast lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Bottoming out occurs when an implant migrates below the native fold. This can occur if the anatomic structures are disrupted during augmentation or if an oversized implant attenuates the support over time.

With regards to your specific question, the risk is operator and implant dependent. Careful dissection during an IMF approach can ensure that the native fold is preserved. Appropriate implant selection is also essential.

While bottoming out is a risk, it is by no means something that is anticipated.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

You have bottoming out. The operation for you is breast implants and a secondary vertical lift to cinch the lower poles. Your nipples should not be raised at all. The implants can go either below or above muscle. The key is the secondary breast lift to tighten your lower poles. The implants need to be placed correctly to give you the upper pole volume you want, so you look great naked or in a bikini.

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Dear sgrmk,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Thank you for your question. Many years ago, I pioneered a technique specifically for patients like you termed "Reductive Augmentation". This involves a Breast augmentation, mastopexy-lift, and excision of the lower pole breast tissue. Please do not have the implants placed on top of the muscle. I have a whole gallery of patients associated with long-term changes associated with implants on top of the muscle. Invariably, the all stretch and bottom out. It is absolutely Necessary to remove the inferior pole excess breast tissue. You should be able to have a beautiful appearing breast with this technique. Best wishes to you.

Thank you for your question and photos. Your question is a good one and while an examination in person is required to properly evaluate you, based on your photos you need a tightening of your lower pole without necessarily elevating your nipple/areola. This may be accompanied with a smaller implant.

Your history of weight loss has permanently stretched your skin and a larger heavier implant is likely to cause future bottoming out. Best of luck to you.

Since you are bottoming out now with your own tissue, I do not recommend placing the implants just behind the breast for you will drop down again. I also suggest going smaller and behind the muscle and repeat the lift. You may need some mesh for better support.

Based on the photos and the provided information you are at risk for bottoming out. It appears you will have the best outcome from revising your lift to remove excess skin from the bottom of the breasts and adding an implant. Implants placed under the muscle have a few benefits to consider. They carry a lower incidence of capsular contracture, the muscle helps to support the implant, and the muscle acts as a camouflage to the upper portion of the implant. I've included a video I hope you find helpful.