Breast Implants Uneven Bottoming Out? (photo)

Hi there I am 2 months post op I have sent thru a before and after pic. As you can see the left in the photo is my concern. I included a one month photo also.. i didnt have the issue then. The crease incision is higher and breast is now lower also the nipples is pointing upward. What could be the problem? Is this normal? I havent done any strenuous exercise or heavy lifting and have followed all my post op instructions. Thanks

Doctor Answers 6

Uneven Breast Implants may be Double Bubble on Right and Bottoming Out

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Thank you for your question. Two months is early and your Breast Implants will settle more over time. I cannot tell without examining you but it appears there may be a Double Bubble forming on the Right Side. Double Bubble is a second area of fullness below the inframammary fold caused by the implant resting below the Inframammary Crease or Fold.

Although it is early, and I sincerely hope that in another month or two the implants will settle and the inferior pole will fall over the Inframammary Crease, I am concerned at this point.

Your Breast Implants are quite large for your delicate frame. When trying to insert large implants into a small chest the surgeon has to dissect a very large pocket. Sometimes this large pocket is too low and bottoming out or Double Bubble can occur.

Be sure to see your doctor about your concerns.

Are your breasts bottoming out?

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You should probably wait until 3-6 months after your surgery to consider a revision. Your final result will settle in by then. Discuss your concerns with your plastic surgeon! If you are bottoming out then here is some information which could help you.

Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.
Bottoming out and Side Boobs Contributing Factors:
  1. Larger/Heavier Implants
  2. Implants placed above the pectoralis muscle
  3. Chronically not wearing a bra when upright
  4. Over dissection of the Implant Pocket
  5. Smooth Implants
  6. Large swings of weight including pregnancy
  7. Skin and soft tissue laxity, loss of elasticity

Bottoming out is not your fault.

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Thank you for your question.

You're doing nothing wrong, the implants are simply deciding where they wish to live over time.  The body tends to be smarter than the physician and is responding to the stress of these new and relatively large implants.  It is not your fault because it is a process that you cannot control, and unfortunately your surgeon does not always have control over it either.  How the tissues relax and settle can sometimes be a product of your genetics.

Part of the reason that these implants have continued to drop is that for your chest they are quite large and have quite a diameter on your frame. You are so slender it is difficult to tell whether they are above or below the muscle.

The muscle is a another force it drives implants downwards over time. I would discuss your concerns with your plastic surgeon, wear a supportive Bra and stay the course for now.  Scar tissue capsule is forming around the implants even as I write this.

Because of the size of the implants relative to your frame elevating the fold once the scar tissue has matured may may or may not hold up.

If you wind up elevating the fold you may wish to consider a smaller and less heavy implant.

I hope this helps.

Adam Tattelbaum, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 115 reviews

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Breast Implant Bottoming Out?

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Thank you for the question and pictures.

Based on your pictures, it does appear that your breast implants have " bottomed out”. This has not occurred because of anything you have or haven't done correctly.

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.  Generally, I use 2 layers of permanent sutures to perform a repair. This is done after careful measurements are made from the areola to the “new” inframammary fold.

I would suggest that you wait as close to one-year post operatively  to have the revision performed;  this timing allows the breast implant capsule  to have matured and be strong enough to hold  suture.  I believe that this timing will improve the chances of successful repair and help prevent recurrence of the implant  displacement.

I hope this helps.

Your implants have dropped over time (bottoming out).

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Thanks for including photos, especially pre-op ones. Your breasts were not symmetrical in position before surgery (virtually every woman has some degree of normal asymmetry!), and your 1 month post-op photo shows implants already in good position. Unfortunately, scar capsules and healing tissues have not completed their normal 6-12 month course of settling and softening seen in all patients (unless they develop the hardening of capsular contracture).

Your 2 month post-op photos show both implants slightly lower than they were at 1 month, something I believe occurs in every patient with normal healing and soft capsules. Your right breast (left in the photo) is now slightly lower than the opposite breast, which actually corresponds with your pre-operative position asymmetry.

Some surgeons believe that implants should be placed into their "proper position" at surgery, and try to maintain this position with surgical bras and/or elastic bandages (Ace wraps). Obviously they believe this "works," but I revise these patients all the time, since their original surgeon may not want to acknowledge that this could ever occur! But that's just my bias, and I'll get off that soapbox now.

The question for you is how low your implants will go as healing progresses over the next 6-12 months. If you are already unhappy with the look of your implant position (nipples "pointing upward"), wearing a bra 24/7 may help to slow the continued drop in position, or reduce the severity of the "final" deformity. If you don't like how things look now, you will likely require additional surgery to correct this when you have reached the final degree of malposition (bottoming out).

This is nothing YOU did wrong or failed to do. But to be fair to your surgeon, he did not know either how much or how fast your implants would drop over time. This is not something that can be accurately predicted in advance.

I actually try to start with a slightly higher position than aesthetically "ideal" right after surgery, actively modifying the rate and degree of dropping with an elastic bandeau at night and no bra during the day until position is nearly ideal, then supportive bra full time until fully healed (6-12 months). This helps to achieve ideal FINAL position in a higher number of patients, as well as less frequent re-operations for bottoming out, and a much easier and likely-to-be-successful re-operation to drop implants that remain a bit too high.

For now, continue to follow your surgeon's instructions, which should be supportive bra day and night, and see how things end up over time. Good luck and best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Bottoming out

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Yes, it looks like your impalnts have bottomed out. You probably could use smaller implants and an adjustment of the fold.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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.