Breast Augmentation Revision? (Photo)

One boob is lower than the other. Did it bottom out? When I lay down there is a four inch gap between my boobs and they fall into my armpits. What should I tell my PS. I hope I'm not the only one that sees this. I had surgery last June. Saline implants.

Doctor Answers 7

Implants will move over time as skin stretches...

Hello. Thanks for the photos, it really helps. From the looks of it, your implants do appear to have settled both downward and outward. The force of gravity is very strong and the skin just stretches due to the weight of the implant. I would speak to your plastic surgeon about how to remedy this. It will likely need surgery to revise the position. 
Good luck.

Columbus Plastic Surgeon
5.0 out of 5 stars 38 reviews

Breast revisions require careful planning and meticulous technique

Your implants do appear to be bottomed out and lateralized (off to the sides). 
They also look subglandular (over the muscle), so it is likely that you may benefit from transfer of the implants from over to under the muscle. I would also likely use dissolvable mesh (Galaflex, less commonly SERI) to help hold the implants in place during the first few months of healing. The goals would be to lift the implants and bring them together. 
Good luck. 

Steven Goldman, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 142 reviews

Implant issue

Yes, not only is one much lower, the two displaced too far laterally. You likely need a pocket revision. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Implant Malposition One Year After Surgery.

Hello, and thanks for the question and the photos. From the photos, it looks like your implants have descended lower and to the side, with the left side being worse. This is considered "bottoming out", but you also have problems (as you have pointed out) with the implants shifting laterally (to the side).
The good news is, all of this can be improved, but it will take additional surgery, and some additional decisions will have to be made. First, it looks like you have fairly thin tissues, and not much fat on you at all, and this may be a factor. Your thin tissues have more trouble supporting the implant. It may be reasonable to downsize, as well as go to a silicone gel implant, which is softer than your current saline. Second, the pockets will need to be repaired at the lower and lateral aspects (and possibly released, or made slightly larger medially, towards the midline). There are different ways to do this, but, given your thin tissues, repairing the pocket by removing a section of the pocket lining (capsule) at the lower and lateral aspects and sewing the edges of the pocket together on the inside will effectively shrink the pocket in these areas. It is also an option to use a sheet of biological material (Acellular Dermal Matrix, or a silk sheet called "Seri") sewn inside the lower half and side of the pocket to give the repair more strength (in addition to sewing the pocket edges together).
This type of repair will place the implants higher on your chest wall as well as centering them so they don't slide off to the side. Of course, you would need an in person physical exam to confirm all of this, but you could discuss this kind of thing with your plastic surgeon.
I hope this helps.

Gregory A. Wiener, MD, FACS
Chicago Plastic Surgeon
4.7 out of 5 stars 75 reviews

Breast Augmentation Revision for Lateral Displacement?

I am sorry to hear about the problem you are experiencing. You demonstrate your concerns nicely. Although some “falling to these sides” of breast implants is quite normal when you lie down, if this occurs “excessively”, it may be a concern to patients. This phenomenon is called lateral displacement of the breast implants. Surgical correction is an option.

Generally, the lateral breast implant displacement can be corrected using an internal suture technique, decreasing the size of the pockets and moving the implants toward the midline. In my practice, I use a 2 layered suture technique to close off the space laterally (towards the axilla). The use of acellular dermal matrix is an option ( although not usually necessary) especially if significant implant rippling/palpability is present.
I hope this, and the attached link, (dedicated to revisionary breast surgery concerns) helps. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Internal bra and implant exchange for low and lateral implants

Without pre-op pictures it is difficult to judge but my guess is that you had a bit of sagging. With saline implants over the muscle this often worsens. They appear to be too narrow, so wider base diameter silicone implants under the muscle will help. Saline implants seem to be more likely to sag and fall to the side, and the tissues there appear to be too thin for adequate implant support. An internal bra with Galaflex or Strattice may be needed, and you may need an external lift as well. 

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

Did it bottom out?

Your photos demonstrate well implants that are low or bottomed out and displace to the sides as well. Your breast tissue is thin and there is "show through" of the implant. Revision of the pocket and a submuscular location can offer an improvement, and a softer moderate profile silicone gel implant is another potential for a more natural look.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 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.