Am I bottoming out at 4 months post-op? (Photos)

Based on you photos, it appears that one side is a bit lower than the other, but it is difficult to tell if this is due to bottoming out or if it is normal asymmetry of your folds.You are doing the right thing by trying to contact your surgeon. If they are not getting back to you, I recommend that you see another plastic surgeon for an in-person evaluation

Dear christinaallie,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 for reassurance and to further discuss your options and possibility of revision.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for sharing your question and photographs.  Unfortunately without an in-person examination it is difficult to confirm your suspicions of bottoming out but I can appreciate the differences in your right and left breasts. Unfortunately after 4 months it is unlikely that conservative treatment such as a bra will correct the issue and a revision may be required.  I would recommend discussing with your surgeon, or seek a second opinion, as to what treatment options exist.  Best wishes. 

Based on your pictures, it does appear that you have a degree of symmetry more than would be expected.  Without an examination it is hard to say what is going on, but it certainly does appear that the one breast appears wider and fuller in the inferior aspect versus the other side.  You are far enough out now that I would not expect any more changes with regards to swelling going down, etc.  I would go in for a follow up with your board certified plastic surgeon or have a second opinion consultation if needed with another surgeon.  I hope this helps.

You are fine. There is no bottoming out in you.  Keep your routine appointments with your surgeon. 

Based on the limited information and photographs, I would say, "no" you are not bottoming out.  Skin does stretch with time, especially with a heavy implant in place, so you could bottom out in the future.Good Luck!

First of all, you have a beautiful result.   It's tough to tell from pictures if you are bottoming out without seeing pictures from right after surgery.  The distance from your nipple to crease does look a little long and your nipples are a little high in your bra.  But this may be the way the implants were positioned at the time of surgery.    If the distance from your nipple to crease is getting longer, then you may be bottoming out. One of the signs of this is when your nipples start peeking out of the top of your bra.     Obviously changes occur early after surgery as your swelling goes away and your implants settle.    With Implants under the muscle, bottoming out is very unlikely unless your surgeon cut your muscle.  I would recommend that you go see your surgeon for a follow up visit for an in-person examination.   

I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are appropriate; one of your breast implants does seem to sit 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 that you may 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.  Any associated issues with positioning of nipple/areola complexes and any visibility of the inframmammary fold scars should improve with this operation.
 I hope this  helps.

When a breast implant migrates below the original placement location with the bottom of the implant just above the infra-mammary crease, we call this “bottoming out.” There are several causes of this downward migration of the breast implant. Usually, some attempt had been made to lower the crease to accommodate a breast implant whose base diameter is larger than would otherwise fit in the natural breast. In doing so, the anatomic attachment of the skin of the breast to the chest wall can be obliterated. There is then nothing to hold the implant up. With the weight of the implant, and constant gravity, maybe lack of support by lack of wearing a bra continuously, the implant can settle downward. One of the earliest symptoms, I see in patients seeking revision, has been the feeling that the breast has to be constantly adjusted or just feels heavy. We look for the incision line, which was previously placed at the crease, to have migrated upward onto the breast. When we see this early on in the postoperative phase, it will never get better with time and will require a secondary repair. While some plastic surgeons may rely on suturing techniques only, I have found that unless we un-weight the implant by making it smaller or strengthen the tissues below by making them less stretchy, that the same implant, with  only sutures placed on the bottom of the pocket, will, over time, recur it's bottomed out position. I have used part of the capsule as well as the lining of the deep muscles and tissues over the ribs in the capsule beneath the breast implants to rotate upward to hold the breast implant in a higher position and therefore obliterating the extra space that has been created between the correct infra-mammary crease and the one created by the downward displacement of the implant. I call this a three flap technique, as the skin, the capsule and fascia (lining of muscles), as well as a dermal flap all contribute to creating a hammock like support of the lower portion of the pocket. When these tissues are insufficient to hold the implant up, or a previous attempt has been made with sutures, I will oftentimes rely on the addition of another type of tissue called an acellular dermal matrix of which my preference is Strattice. This Strattice, or pigskin, does not stretch and can be sewn in to the bottom of the new location of the crease to support it just like a hammock would. Although this is costly, I consider this an insurance policy against having to redo this again. I would recommend that you try and find a plastic surgeon with experience in revisionary cosmetic breast surgery. Good luck.