Have my implants bottomed out? Should I get larger ones so there's more middle cleavage? Maybe switch to overs? (Photo)

The gap between breast I feel is too large. I think they appear to have bottomed out, as my scar is way higher than most. I am 9 months post op. I have 535cc ultra high profile silicon cohesive gel in both, under the muscle. Any recommendations if I should switch to over the muscle to look larger with a bigger size implant? I feel they sit too far apart and appear very small for the amount of cc I got. I am 4'11'' 110 lbs. I was a very tiny 32 a cup before.

Doctor Answers 8

Improving implant results

Thank you for your picture. Yes your distance between your areola and your crease is a bit large but it seems to work for you. The implants typically follow your normal anatomy. I do not think they can be closer. If you want them to sit higher then you will have to shorten the distance between the areola and the crease by removing tissue and placing STRATTICE  to support your implants in the higher position. 

Have my implants bottomed out? Should I get larger ones so there's more middle cleavage? Maybe switch to overs?

Yes the right in the posted photo is "bottoming". You need revision surgery with tightening inferior pocket with suture technique or ACD matrix, or both. As for "gap" I do not believe this is correctable and I see an acceptable gap.. Please seek IN PERSON opinions and fee quotes. Sorry for your issues... 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Implants bottoming out

If your incisions were placed in the folds, you have had some mild bottoming out. The bigger problem in my opinion is the choice of implant profile. Despite your short stature, you would benefit from a larger base diameter implant to soften the transition from your thin upper chest to your breast. This could be done at the same time that the breast pockets are plicated to correct the bottoming out and would give you a nicer shape to your breasts.

Don W. Griffin, MD
Nashville Plastic Surgeon
4.8 out of 5 stars 72 reviews

Bottoming out implants

Thank you for your breast implant question.
  • Yes, your implants are bottoming out - they are moving down your chest, below your breast.
  • The distance between the implants is one of your own anatomy
  • Trying to get the implants too close will end up with implants across the chest, popularly called 'uniboob.' You do not want that look.
  • You have large implants in a small frame. 
  • A smaller pocket with correctly placed implants may give you the look you want
  • Implants over the muscle look larger than ones under the muscle.
  • I would consider having these implants removed, the breast crease repaired, possibly supporting the lower pole with some kind of ADM and having textured over the muscle implants.
  • I would not try to go to a larger implant - they are likely to cause you more problems. Best wishes.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Bottoming out of UHP implants

In your first photo it appears that the breasts have bottomed out.  This is the primary problem with the ultra high profile implants.  The are very dense with a narrow base and if the soft tissue can not support the implant they bottom out.  I would suggest smaller implants using a moderate plus or Style 15 Alleragan implant with an inferior capsulopexy and placement of fold sutures.  May even consider the use of a mesh like Seri or and ADM product for additional lower pole support.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Why a larger implant is not always a good idea....

This is a good question, the problem is not the large implant which is what you have (>450cc).  It is the placement of the ultra high projecting smooth round implant.  Large smooth implants drop.  Gravity and weight overcome the strength of skin and the soft tissue.  In fact, many patients, switching to a textured implant, while correcting the fold, frequently can appear fuller in the upper breast and be maintained with a smaller volume.  My recommendation is the Sientra shaped implant line which are all textured.  However, if you wish not to switch, do not go larger as you will have a more bottomed out result over time.

Peter J. Capizzi, MD
Charlotte Plastic Surgeon
4.9 out of 5 stars 84 reviews

Not a simple answer

For your frame your implants seem a bit big. The solution is definitely not to go bigger, and also not to go above the muscle. If yiu are not pleased with your plastic surgeon you might benefit from a consultation with another qualified board certified plastic surgeon skilled in breast surgery who can advise you on how to best address your aesthetic concerns. In general, the two reasons implants "bottom out" are disruption of the inframammary fold and/or use of implants that are too large and heavy.

Ram Kalus, MD
Mount Pleasant Plastic Surgeon
4.8 out of 5 stars 23 reviews

Have my implants bottomed out? Should I get larger ones so there's more middle cleavage? Maybe switch to overs?

Thanks for your question. I agree that they are too low. In order to correct this you would need further surgery to adjust the infra mammary fold from within by working with the existing capsule. As far as the distance between your breasts I don't think you can expect much closer......maybe a bit by switching implant profile. A word of warning, be careful of switching from a submuscular to a sub glandular position and the possibility of creating symmastia.  I would suggest a moderate plus profile, smooth silicone cohesive gels in the 500 cc range. The combination of the capsuloraphy and change of profile should sufficient to correct the bottoming out, the space between the breasts and give you more upper pole fullness. Good luck

Jose Perez-Gurri, MD, FACS
Miami Plastic Surgeon
4.9 out of 5 stars 232 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.