Was my Breast Revision To Correct CC and Bottoming Out Done Correctly? (photo)

Went to a revision specialist to correct the following: Capsular contraction - left breast. Bottoming out - right breast. Surgeon performed: Capsule removal on left breast. Permanent sutures to form new pocket on right breast. Implants were replaced. Went from 500/left 550/right to 600/left to 650/right. I am 7 weeks post-surgery. I am very upset. My breasts are totally uneven, even more so than before the surgery. Right breast is very firm and tight. What should I do? Please help!!

Doctor Answers 10

Answer to RealSelf.com Breast asymmetry question

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There are many different issues that you are dealing with: capsular contracture, scarring, capsule reefing, larger implants, revisional surgery, and normal healing...just to name a few.  Each of these variables increases the risks for asymmetry and many of them cannot be controlled by either you or your surgeon.  

It appears from your photos that the diagnosis of capsular contracture on the left breast was correct, although I am not able to appreciate any significant "bottoming out" on the right breast before your revision.  If you had a total capsulectomy on the left and no capsular release or removal on the right, the result that occurred is predictable.  However, as time moves forward, you may develop some degree of capsular contracture again on the left that will elevate the breast again.  Therefore, no matter what you do, I would encourage you to wait at least a few more months before considering a revision.  When you do make a change, I would also suggests that you decrease the size of your implants.   Be patient for a while, then go in and discuss your concerns with your plastic surgeon.  Good luck.

Revision of breast surgery

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Not sure why you did anything to the Right breast. That looks pretty good to me. The left side looks like it just had a contracture so that it didn't drop. I can see why you are unhappy because of the asymmetry. You need to decide which breast you like better before you have further surgery. Each breast looks good, but different. Change only one. I bet you had some asymmetry issues before you had your first surgery. Those photos would be worth reviewing with your surgeon.

Revision Breast Surgery

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Thank you for your question.  Unfortunately, it looks like you may need another revision.  Is the right breast more firm? you may be developing capsular contracture on that side.

Revisionary surgery is tricky and there are always risks associated with any type of surgery.  Make sure you see a board certified plastic surgeon who has experience with this type of surgery.


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Revision surgery is likely.

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Unfortunately, you have had a poor result from revisional breast surgery. Looking at your preoperative photos, I do not appreciate any "bottoming out" of the right implant before surgery, although it does appear that you have an elevation and tightness consistent with capsular contracture on the left side. The implants you have are far too big for your breasts. Correcting positional deformities while increasing implant size will complicate any revision. Your postoperative photos show that the right breast implant is elevated, giving an asymmetric appearance. This may improve a bit over time, however a revision is probably likely. Decreasing the size of your implants will help as oversized implants will tend to distort over time.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Your implants are too big for your breast tissue

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This a very common problem with revision surgery. There were enough issues to correct and adding bigger implants makes the situation even more complicated. You need to get another revision and smaller implants.

Capsular contracture to breasts, breast revision surgery, bottoming out breast shape

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I am sorry to hear that you are having problems following your revisional surgery.  I don't want to comment specifically to your situation because I have not directly examined you and the advise should be offered only a fter a proper examination.  In general, however,the idea of removing the existing capsular contractures from a breast that is tight and distorted in its shape is a good idea.  Supporting the undersurface of a bottoming out breast shape with sutures or a dermal graft( called ADM) is also a recommended idea.  I have usually downsized the implants to a smaller size with each revision of this type in an effort to put less weight  on the new repair.  I believe that it is more difficult to keep an elevated and softer appearance to the new breast shape when  larger implants are used.

I always advise patients to  consider further consultation with the Plastic Surgeon who has performed your previous surgery for further  guidance in this matter.  Good luck.

Was Breast Revision To Correct CC and Bottoming Out Done Correctly

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Breast #revision surgery is more difficult, complicated, and requires more time than primary surgery. Capsular contracture may recur regardless of surgeries being performed at this time and may require additional surgeries. There is as much as a 40% chance!!! that additional surgery will be needed following this operation. Also, any asymmetries regarding the folds under your breasts will not be totally corrected.

An #increase in CC's may also require a Breast #Lift to to #tighten loose skin, better optimize the end result.  I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring. Other factors which contribute to the outcome are #size, #shape, and #profile.  The #profile is determined by the amount of #projection versus roundness that the you desire, as well as the #size of the implant and size of your chest. Also, the placement or incision location will also have an effect on profile. 

If this is unsatisfactory, it may require additional surgery which will also require additional surgeon’s fees, operating room and anesthetic fees.Typically, it's best to wait 6 to 12 months depending on the reason for #revision.

Was my Breast Revision To Correct CC and Bottoming Out Done Correctly? (photo)

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Sorry but you need additional surgery. Please call my office in MIAMI to we can discuss your options in person. regards 

You will need a revision breast augmentation in 3 or 4 months.

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1)  I am afraid that you do not have an acceptable result, and you must be so upset.  You should wait though, to make sure they don't change.

2)  From your picture, I would recommend that the right breast mound  be lowered to look more natural.  I would also suggest going a little smaller.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Bottoming out of breast implants

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You have two problems going on. First of all, the right breast appears to be developing an early capsular contracture. Further, the left breast appears to still be bottomed out. They are both tough problems to repair. Fortunately the answer to repairing both my be either Alloderm or Strattice. They have both been shown to reduce recurrent capsular contracture in some patients. Further, both can be used to re-support an implant requires more support.

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.