Capsular contraction, big gap between the breasts, and maybe bottoming out? (Photo)

I am 5'8 and 56 kg, before surgery, one year ago, I was 32b, I got 450 cc hp profile, silicone, under the muscle. In my left breast I have capsular contraction, and I suspect that I have bottoming out on the right side, my breast looks low,wide and to the sides, and nipple pointed up and to the right:( I really want to get a nice cleavage and to get an upper full,round look. What procedures do I need? I decided to go with bigger implant, can't decide which one I need for that 500cc HP or 600cc?

Doctor Answers 9

Capsular contraction, big gap between the breasts, and maybe bottoming out?

Thank you for the question and pictures. Unfortunately, online consultants will not be able to provide you with specific enough advice to be truly helpful.  It is possible, however that you will benefit from revisionary breast surgery that will likely include maneuvers such as adjustment of the breast implant capsules (capsulorraphy),  the use of acellular dermal matrix if capsular contracture is present, and/or adjustment of the breast implant size/profiles. Generally speaking, the best online advice I can give to ladies who are considering  revisionary breast augmentation surgery (regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals  with your plastic surgeon. This communication will be critical in determining  breast implant size/type/profile will most likely help achieve your goals. 

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as  “natural” or "C or D cup" etc means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

3.  Once you feel you have communicated your goals clearly,   allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery (after the use of temporary sizers assessed with you in the upright position).

I hope this (and the attached link, devoted to revisionary breast surgery) helps.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Revision surgery should resolve those issues.

If you schedule an appointment with a board certified plastic surgeon who specializes in breast implant revision surgery, I think that all of your concerns can be resolved. Be sure to bring the photos of your ideal look with you to your consultation, and don’t worry too much about how many ccs you should choose. It’s your surgeon’s job to determine that based on your goals. Also, cleavage is often dependent on your anatomy. If your breasts are naturally further apart, they won’t be pushed together during surgery. As always, it’s important to maintain realistic results about what you can expect after your revision.

David N. Sayah, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 8 reviews

Internal bra for revision for combination implant issues

Diagnosis of a capsular contracture would require an in-person exam, but the photos do appear to show some bottoming out on the right side. They also appear to be relatively large implants which are difficult to support in a thin person, so be cautious about going larger. One option might be an internal bra using SERI Scaffold silk, Strattice, or similar material to hold the implants up an closer together. If you do have a CC, then this will be very important because the treatment will involve removal of the scar capsule, leaving even thinner tissue to support the implants.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Remedy for Bottomed out Breast implant

Surgery is the only effective remedy. Revision surgery is almost always more complex than breast augmentation. Correction techniques vary based on your plastic surgeon’s experience and skill sets. Always choose a board certified plastic surgeon with expensive revision experience as even in the best of hands recurrence is frequent especially if larger implants are used. Repair techniques include some of the following techniques and recommendations:
  1. Textured implants (“Velcro effect”)
  2. Use of Smaller Implants
  3. Maximum Submuscular Position (not just the pectoralis major but abdominis rectus below and serratus anterior on the side)
  4. Capsulorrhaphy (tightening the pocket by sewing in-folded capsular tissue together)
  5. Use of Biologic fabrics and other materials such as Acellular Dermal Matrix, “ADM” Alloderm, Strattice, “Silk” and others that can be used to reinforce the bottom of the pocket.
  6. Change of position of implant to a new pocket location “neo pectoral pocket”
  7. Internal Ryan Procedure (sutures binding the inferior mammary fold to stronger underlying tissues (e.g. fascial, periosteal)
  8. Removal of Implants and replacement of volume using your own fat (Fat Transfer).
The procedure is performed under general anesthesia on an outpatient basis most often using an existing scar or making an incision beneath the breast. Recovery is similar to your original breast augmentation procedure. Use of taping after surgery and prolonged use of a support bra is often recommended. It is far more important to pick the best plastic surgeon rather than trying to pick the best procedure as they are in the best position to guide you to the right decision.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Revision needed?

Thank you for the question and photos. I believe that a complete revision is necessary. Your size looks good so you have a few options. You could continue with round high profile implants or switch to a highly projected tall height shaped silicone gel implant which will maintain a full and nicely shaped upper pole and similar breast projection. I would recommend also the use of a dermal graft in the lower pole for support and capsular contracture prevention. You are young and thin and revisions are expensive so I recommend going for the most reliable single procedure. Discuss this with your board certified Plastic surgeon. In the implant revision section of my before and after photos there is a similar case, at

Breast implant revision all surgery

Thanks for the question.  I think the challenges you are facing center more on the balance, capsular contracture removal and bottoming out correction.  It would certainly confuse your overall correction by increasing the size of the implants 

my recommendation would be to try to
correct the obvious problems first.

Good luck to you.

Bottoming out

Yes, it looks like you have some "bottoming out" on the right side.
Typically, we see these 3 features when this happens:
1) loss of upper pole fullness
2) upward orientation of the nipple
3) increased distance from nipple down to infra-mammary fold.

This could probably be fixed with internal suturing of the pocket, reinforced with Strattice or similar material.  I would advise against going larger - the extra weight of the implant works against the chances of the repair healing properly.

Thomas Fiala, MD
Orlando Plastic Surgeon
4.9 out of 5 stars 79 reviews

Capsular contraction, big gap between the breasts, and maybe bottoming out?

If you increase the size you might be just chasing your tail.. You need to obtain perfect symmetry first than as a second operation increase the volume size... 

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

Breast augmentation, sizing, #cosmeticsurgery #breastcontouring

Dear BeautifulBreasts

Thank you for your question!  The capsule contracture and the bottoming out can be challenging - especially with large implants in a small frame like yours.  A detailed consultation is very important- as the long term consequences- such as the need for MORE surgery are serious.
You should discuss this with your surgeon- the favorable procedures such as Strattice and SERI have their own risks and do not necessarily prevent long term issues.
With Warm Regards

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 115 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.