4.5 post op, smooth silicone, 371cc, under muscle. Are my Breast Implants Bottoming Out? (photo)

My right implant may be bottoming out. I'm 4.5 months post-op & received smooth silicone, 371cc, under-muscles. 1st photo is 24 days after surgery & the next 3 are recent. I feel like my right breast is becoming more uneven with my left, & that the nipple & incision are rising. I started exercising shortly after surgery & am wondering if that could cause bottoming out, even though my PS said it was totally fine if it felt ok to do & that it wouldn't effect it (since he makes "tight" pockets).

Doctor Answers 11

Bottoming out of breast implants

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Thank you for your question and including photos.  It would be nice to see pre-op pictures to see if you had some asymmetry to start with. Most women have some asymmetry.

It does appear that your right breast has bottomed out some.  It also appears slightly larger than the left. You may have some seroma fluid around the outside of the implant and inside the capsule.  This could develop from early exercise stimulating fluid production. This can stretch the pocket and contribute to bottoming out. It's hard to say without examining you.

You also could possibly have a capsular contracture on the left.  Again, its difficult to tell from photos alone.

For both of the reasons, you should return to see your surgeon to see what he/she thinks. You may at some point require some revisional surgery.

I hope this helps.


Healing is a dynamic process.

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It’s not unusual for patients to note implant malposition in the immediate postoperative period.In many cases, this is transient and related to swelling and muscle spasm.For this reason, revisional surgery should be delayed for at least six months following surgery.Prior to this time, corrective surgery involves trying to hit a moving target because wound healing is such a dynamic process.At six months, muscle spasm, skin tightening, swelling, and inflammation associated with wound healing have improved sufficiently to obtain a good result.
It’s obvious that your left breast implant has drifted downward and is now creating significant asymmetry when compared to the opposite side.It’s also interesting to note that your preoperative photos demonstrate some nipple areola asymmetry, as well.This degree of asymmetry will ultimately require revisional surgery, but this should be delayed until you’re at least six months post-op.Correction would require a procedure known as a capsulorrhaphy.This procedure involves placing sutures in the lower breast pocket to raise the height of the inframammary fold.The procedure provides correction of the problem and is associated with high satisfaction rates.
If you’re concerned about implant malposition, it’s important to consult your plastic surgeon.Your surgeon should be able to formulate a plan that addresses your concerns.

Bottming out breast implants

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From the photo, it appears that it is your left side that is having the issues. Yes, working out the pec muscles can create a piston effect and push on the implant.  I would suggest discussing any revisionary surgery with your surgeon.  Internal suturing can be done to tighten the pocket. 

Click on the example below of bottomed out breasts treated with capsulorrhaphy. 

Yes, your right implant has dropped too low ("bottomed out").

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With respect to my colleagues, when a patient photographs herself in a mirror, the image is reversed (try this yourself) and indeed your right implant has dropped too low, causing the nipple position and scar to look "too high."

Your right breast also looks larger than the left, though it did not look abnormally asymmetrical in volume in the 24-day post-op photo. This could be blood or seroma, but clearly needs evaluation as well.

Your incision (and nipple) did not "rise," your implant dropped lower than anticipated, and certainly lower than the other side. Exercise could have contributed to this, or it could have happened on its own even if you had been totally inactive. Of course, over-activity can also contribute to fluid or blood on this side.

Both implant position and the question about size (blood or seroma?) require re-operation. See your surgeon.

So much for his "tight pockets." Sorry; you should have been told to restrict strenuous activities until healed and in proper position, regardless of how "tight" his pocket creation is! Best wishes!

Bottoming out after BA

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Is it just me....in the photos it looks as if it's your left nipple that is too high and the left implant too low.  The breast is bottomed out and the pocket needs to be revised.  Working out soon after surgery could definitely have contributed to the problem if you did chest exercises like push ups.  When the pectoralis muscles contract the force is translated onto the implant and in the early stages can push it out of place if done often.  Once the capsule is mature it will resist this movement.  Remember this after you get the pocket repaired.  Good Luck!

Your left implant is bottoming out

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The pictures show the right implant placed too low. You may have some capsular contracture over left breast. Please see your surgeon for further evaluation and possible revision.

Breast Augmentation revision using the natural beautiful subfascial plane

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unfortunately there are several issues here that are very common with placement of subpectoral breast implants, especially when high profile narrow implants are placed.  They usually start out too far lateral ( to the sides) because of the remaining attachment of the pectoralis muscle to the sternum.  the continued everyday tone of the muscle and increased tone with every arm movement commonly lead to the descent and further displacement to the sides.  Look in the mirror, put both hands on your hips and firmly push down hard with both hands and you will see what I mean.  There are strong forces that cause a strange appearance and the implants move down and to the side.  This is one of many reasons that I do not perform 'dual-plane' or submuscular augmentation.  I use a technique called subfascial breast augmentation.  This should not be confused with 'subglandular' or 'above the muscle' as it is completely different.  In subfascial augmentation, both the breast and the muscle are left alone.  A strong natural living layer called fascia is carefully dissected from the underlying muscle and this fascia is used to create a teardrop shaped breast with natural living support( like a bra inside the breast). 

I commonly see patients with situations like yours and I feel that the best way to get beautiful results is to convert them to subfascial augmentations.  I use a modified technique called 'cold-subfascial augmentation'  that allows maximal fascial support which you will definitely need especially on the left where the inframammary fold is excessively lowered( a difficult problem to address with conventional techniques.  Other techniques that use products to hold the implant are usually short lived at best and using the capsule itself is never a long term solution.  Another caveat that helps me attain a natural look is using low profile implants that end up appearing to have excellent projection because of the fascial dissection design (tear-drop).  

All the best,

Rian A. Maercks M.D.

Nipple rising up on one side after breast augmentation

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The cause of the nipple on one side drifting upward after breast augmentation is indeed a bottoming out, or low position of the breast implant. As the point of projection drops below the nipple, the nipple appears higher. Unfortunately the pocket will need to be repaired to center the implant under the breast as like the opposite side.

Best of luck, peterejohnsonmd

Bottoming out?

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Thank you for the question and pictures.

I think you are correct in that one of the implants has settled significantly more than the other. I think you will require revision surgery to improve the situation.

One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).

Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. This is corrected by “raising” the inframammary fold using internal sutures. This is done after careful measurements are made from the areola to the “new” inframammary fold. The  correction will improve the symmetry of the inframammary fold areas and “centralized” the nipple areola on the breast mound.

I would suggest continued follow-up with your plastic surgeon and plan the revision if you feel that he/she has  the expertise to correct the  implant malposition.

I hope this helps.

Right breast implant problems

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You do seem to be having some real problems with that implant and it clearly has bottomed out perhaps from excessive exercise.  Also, it looks like you might have an early capsular contracture so both of these issues should lead you back to your doctor for a visit and an exam and some revisionary surgery.

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.