Hi, I´m from Brazil, 34 years old female and 7 weeks post op. Since 1 week pots op I concerns about my left breast has bottoming out. I am a thin patient (130lbs, 5ft4in. 34A pre-op and did 330cc perthese ultra high gel coesive implant. My breasts before were very symmetrical though! Dr. said that we will wait at least 3-6 mths before we decide on anything. He would never say to me bottoming out though. What can I do now? Are my breast implants bottomed out?
Are my Breast Implants Bottomed Out?
Doctor Answers 38
It looks like in the photo that the right implant is bottoming out a bit. An in person exam would be helpful. To treat this usually requires resuspending the fold internally with sutures and often placing smaller implants.
Analyzing your photographs, there is -currently- an asimmetry: the right breast inframmamary fold is a little bit lowered comparing with the left side. i don't think it's a real bottom out. I think that in a very near future (3-6 month postop it will have to be fixed surgically [reconstruct the lowered fold]. It's very soon in this moment. I would try to use a "chest-band" (Veronique) -2 inch width- during daytime trying to fix the problem.
In the other hand, it's completely necesary to analyze your preoperative photos. I think that probably existed preoperatively a minimum degree of asimmetry (not only in inframmamary fold but in de nipple-areola complex simmetry). I think that your plastic surgeon's analisys will help you with the right decission.
Probably not bottoming out
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Your Right Sided "Bottoming Out" Is Easily Repairable
Your Right sided implant is positioned too low and will have to be moved up at about 6 months after surgery.
- Al though "Bottoming Out" is used to describe implants that have expanded the lower portion of the breast excessively usually much later than 7 weeks, your right breast implant is positioned too low.
- This has caused a noticeable difference in your breasts (asymmetry) and will probably have to be fixed surgically. You should wait until approximately 6 months after surgery to make sure healing is complete and that no further changes will occur. At that point the symmetry can be improved with a relatively straight forward capsulorrhophy (tightening) of the pocket on the right side. This should bring the right implant back up and greatly improve your result.
Breast asymmetry after breast augmentation
Certainly your photo shows significant asymmetry in the breast. The fold on the right is indeed lower and this may be related to shape and asymmetry beforehand. It could be caused by an implant pocket which is simply too low on the right. The fold may have to be reset but Best now to wait though and let the skin envelop relax and accommodate the implant.
Best of luck,
From the photos it looks like possibly there is some implant mal-position of the right breast. You are only 7 weeks post op and you need to allow for things to heal completely before considering revisionary breast surgery. I perform lots of revision breast surgery and almost always ask patients to wait 6 months to 1 year to allow for complete healing and also this time frame will allow for a better result with the revisionary surgery. To correct "bottoming out", capsulorrhaphy would need to performed with permanent sutures to improve the placement of the implant on the chest wall. Make sure your surgeon has experience with this type of surgery - ask questions - get references.
I had bilateral breast augmentation in Brazil Are my breasts bottoming out?
Breast Augmentation asymmetry
You do have asymmetrical results, but it would be helpful to see your pre-surgery pictures to be able to fully comment. It does appear that your right breast shape is different and lower than the left breast. Do you have shaped implants? It is possible that the implant has rotated. If you have round implants then perhaps the implant has displaced itself.
If you are unhappy with your surgeon's recommendation, you should not feel guilty about asking for a second opinion, like you are doing here. Here, however, we are limited in the amount of information you have provided us and the inability to examine you.
Martin Jugenburg, MD
Bottoming Out Vs Malposition???
I would agree, the terminology is kind of vague. If you came to me 1-2 years after getting your implants complaining of the assymetry now that was perfect before, I would diagnose your right implant as having bottomed out, but only "slightly". If you have this appearance at 1 week post op, then the right implant has been positioned slightly too low. This may have been in an attempt to release an inframammary fold that was too high, or from release of a Pectoralis muscle attachment that was too high. But, this is just speculation. In any case, I would recommend waiting for about 6 months to allow development of a sturdy capsule to help in the repair of this. Rapair of this problem does tend to have a fairly high recurrence rate. If repair is needed sooner, then it can be done at any time. I would probably also consider using a reinforcing tissue called Strattice.
Implants bottomed out
The term bottoming out is very non specific. It is better to think of implant displacement that creates an undesired or unaesthetic appearance to the augmented breast. It is difficult to give advice from photographs which is complicated by the fact that the implants you discuss are not available on the US market. From your photographs, it looks like the distance from the nipple to the fold on the right side is increased versus the left. At this point, I am certain you demonstrate an improvement from your appearance preop. Allowing an interval for healing and the resolution of swelling is required. I think follow up with your surgeon at three and six months is appropriate.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.