Can I go bigger after bottoming out? (Photos)

Question

I have 400cc implants and would like to exchange them for 600-650cc Im 5 months post op and realized Im bottoming out. I still would like to go bigger. Is this possible?

Jed H. Horowitz, MD, FACS · Answer

"Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.
Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant. This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold.With any surgical procedure, there are some risks which your doctor will discuss with you during your consultation. It's best to consult with a board-certified plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your breast #procedure. You will then greatly improve your chances of getting the result you desire, and, without the need for a #revision surgery. Aside from checking board-certification, it is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision. Please be advised that each patient is unique and previous results are not a guarantee for individual outcome.

Shlomo Widder, MD · Answer

Dear rdrs,   Thanks for submitting your pictures and sorry for your problem. From observing your pictures, you appear to be full C cup size with significant double bubble defoermity.   Most likely, you had mild to moderate ptosis before surgery and your surgeon tried to create perkiness by lowering the sub mammary  crease , which did not stretch , creating the double bubble deformity.    Going bigger is possible, however, before doing so, you will need to correct the double bubble deformity with inferior capsulorrhaphy (internal bra) and, most likely mini lift procedure (donut, Benneli) , in order to give you beautiful perky breasts. These procedure will make the breasts appear bigger, so that you will not need to go with 600 - 650 cc , because heavy implants increase the risk of relapse of the double bubble due to the downward pressure. Going to 500-525 cc, most likely will suffice to bring to full D cup size.   Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation  in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage and sub mammary fold, perky, symmetrical and natural looking.                    Best of luck,                                          Dr Widder

Nathan Eberle, MD, DDS, FACS · Answer

it appears your have a double bubble from an overly dissected inferior pocket, which is not bottoming out per se. You can always go bigger, however, going bigger while at the same time trying to repair the fold malposition/double bubble is not such a great idea. You need to spend some time with a few plastic surgeons discussing your options, likely not the one who performed the initial surgery.

Steven Wallach, MD · Answer

It would not be a good idea to place larger implants if you already are bottoming out. You need a capsule repair  and may even need smaller implants to fix this.

Bennett Yang, MD · Answer

Hello and thank you for the question and the photo. It is not uncommon for patients to want to go bigger in the first year after surgery. I would caution you to pick the right implant just not for today but for the next ten years or more. Many patients who want to go bigger at six months will not feel the same way a year later. I would suggest you wait a little longer before making that decision. Second; there is some bottoming out, but the reality is that the new implant is lower and wider than your natural breast diameter. You will need to consider having the capsule tightened as well as having your breast tissue scored to help let it hide the boundary of the old inframammary fold. If you are set on going larger, another consideration would be to switch to a textured implant. the textured implants seem to do better with less risk of bottoming out or lateral malposition in my experience. Best to you.

Tom J. Pousti, MD · Answer

I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair).  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. Whether or not you will be able to have larger breast implant utilized safely will depend on careful measurements of your chest wall dimensions, especially after the the repair has been performed.  In my practice, this is best determined using intraoperative sizers during surgery after careful communication with the patient prior to surgery.
Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with this type of revisionary breast surgery. 
I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.

Can I go bigger after bottoming out? (Photos)

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