7 months post op, no upper pole fullness - am I bottoming out? (photos)

Question

Hi all! I had a breast aug in Dec 22. I had 220cc high profile implants placed submuscular. I originally wanted to do 240/265 but the surgeon said he couldn't close the incisions with 240 in so he went with 220. I wish I had got bigger but anyway, am I bottoming out? I feel like I have no upper pole shape or fullness and most of my implant sits on the bottom/side. Not much going on in the middle.

Daniel Barrett, MD · Answer

Dear nursej2,
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

Jeffrey Lisiecki, MD · Answer

Yes, you are bottoming out a bit.  The other issues with your shape are probably to do with the implant selection.  For a given size, a high profile implant actually gives less upper pole fullness because it doesn't go as high up the chest wall as a lower profile implant.  Based on the sizes you mentioned, I assume these are Allergan implants, so a 220cc implant would only be 10cm wide, which might be a little small for your base width as well.  Assuming your base width is over 10cm (most people are), an implant that is slightly larger in volume and in width would help fill up your upper pole and medial breast, along with tightening the capsule to help with the bottoming out and to push the implant more medially.

Gerald Minniti, MD, FACS · Answer

Yes, you did. Now you can get larger implants, but you'll need mesh to support them. If your surgeon isn't a revision breast specialist, you should go to someone who is.

Harry T. Haramis, MD, FACS · Answer

You do not appear to be bottoming out as the fold and pockets look intact. Would need to compare with pre op to determine lower fullness.

If you want more upper fullness, larger implants may be an option.

Further discussion with your/a plastic surgeon is recommended.

Michele A. Shermak, MD · Answer

Hello.
It does look like the implants are sitting low. Were they higher before? It also looks like your access scar is at the fold and not above it, so the implant was placed in that position and did not drop?
Your crease can be set a bit higher to bring the implant up higher. You may need some support of the lower breast to maintain the higher crease, like that provided with Galaflex.
I would recommend you see a board certified plastic surgeon in consultation. You can find one at plasticsurgery.org.
Best of luck to you!

Camille Cash, MD · Answer

From the photos submitted the implants are setting too low with the nipples pointing upward.  A revision to tighten the lower pole of the breast should help.  An exam is needed to give the proper recommendation, but mesh may be useful for you.

Connie Hiers, MD, FACS · Answer

Yes, you are bottoming out from the stretch and weight of your implants on your tissue. Your lower pockets could be tightened and you might need mesh for more internal support.

Darryl J. Blinski, MD · Answer

Nicely posted photos, I find it hard to believe the initial surgeon could not use a larger implant volume? I see no bottoming but I recommend exchange to High Profile 300-350cc. Best to virtual consult with....

Douglas J. Raskin, MD (retired) · Answer

Greetings,
It is possible that you would benefit from larger implants to fill your upper breast poles. It is not possible to speculate about your best volume target (and less likely breast lift needs without an examination and consultation(s). Online photos alone do not provide enough information.  It is very important to discuss all surgical options with your plastic surgeon(s). To achieve your desired outcome, a procedure decision is best made after you candidly have described your objectives and re-evaluated potential revision risks. 
Best Regards,

7 months post op, no upper pole fullness - am I bottoming out? (photos)

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