Am I bottoming out or were my nipples placed too high? (photo)

Hello,The surgery you had is the most difficult primary breast surgery to perform consistently well, and has the highest rate of complications when performed by inexperienced, poorly trained, or unskilled surgeons. Unfortunately, there are a vast preponderance of those type of surgeons around all too willing to perform the surgery. Based on your photos, there is an element of both dropout and inappropriately high placed nipple areolar complexes. The remedy will not completely fix the problem, but a combination of smaller implants placed higher on the chest wall with a revision lift (where as much skin as possible is removed from the inframammary region) should be performed. Going back to the surgeon you went to doesn't make sense from any standpoint, even if he did it for free. Go visit a few ABPS certified/ASAPS member surgeons who specialize in revision surgery. 

  As you have said this either happens with nipples being placed too high or implants too low. I wish I could see more of your chest wall and see exactly where your collarbone is in relation to things because if you have a lot of space still from your collarbone to your nipple then your problem could be dramatically helped  by moving your implants uphill, also called a capsulorrhaphy.  But remember moving implant uphill against gravity is a tough operation. But that will do two things. It will receptor your nipple and it will move the bottom crease of your breast up, which allows the bottom of your bra to sit in a better location and cover the nipple!  But make sure you find the right doctor because again, it's harder than it seems!!

Thank you for your pictures and questions. Please make sure that you are seeing a plastic surgeon who is board certified by the American Board of Plastic Surgery. If you did not, then go see one for a consultation. If right after surgery, you were pleased with things, then I would say that over time, you have had stretching of the lower part of the breast, leading to pseudoptosis, which will require a revision. If you had very high nipple position even right after surgery, then it is possible that the nipple was placed too high to begin with. This can be very hard to repair properly, so make sure you are seeing the right surgeon. Usually revision procedures are going to come with at least some cost to the patient, even if the surgeon waives his or her professional/surgical fees.Hope this helps!

Dear youngmommyofone,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. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Hello and very sorry to hear about your difficulties after your lift + augmentation.  After reviewing your photos it appears that you have both bottoming out and slightly high NAC positioning.  This is usually a relatively straight-forward revision lift that can typically be done under local anesthesia in the office and shouldn't be overly costly and might be offered gratis.  I would recommend that you discuss your dissatisfaction with your surgeon and work to find a solution together.Best wishes,Dr. Brown

Sorry that you are unhappy with your outcome. The photos were very helpful. Based on what can be seen on the photos but without a history or examination, it appears that the nipples were placed too high. As you have found out, this also translates into major issue wearing many types of clothes because your nipples will be quite visible and uncovered. Surgical correction will be needed. You can discuss your concerns with your surgeon (is he/she certified by the American Board of Plastic Surgery?) as well as week second opinions from one or more reputable board certified plastic surgeons.Good luck!Steven Turkeltaub, MD

I am sorry to hear about/see the problem you are having after breast augmentation/lifting surgery.   Careful physical examination (measurements) would be necessary to provide you with an accurate response but I think your concerns are appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”). 
 Generally, signs of breast implant bottoming out include: 
1. Breast implant "sits" too low on the chest wall.
2.  Excessive palpability or visibility of the breast implant along the lower breast pole.
3.  Nipple/areola complex seems to be sitting relatively high, because the breast implants have settled too low. 
4. Discomfort along the lower breast pole (secondary to pressure from the underlying implant).
5. Relative paucity of upper pole breast implant volume compared to lower pole volume.
6. Increased visibility of a infra mammary fold scar (higher on the breast mound).
I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). Sometimes, depending mainly on the patient's history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh. This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation.  
Best wishes.

Because the side view shows that the implants are not going below the scar (that would be bottoming out) I would have to say that the implants are sitting right where your surgeon designed them to be. Therefore, I would think the nipples were placed very high. Best to review your preop photos and current ones with your surgeon.