Bottoming out revision cost? Will my surgeon redo for free?

Question

If I need my bottoming out fixed will I have to pay again? What is your normal remedy for this?

Urmen Desai, MD, MPH, FACS · Answer

Every surgeon has a different policy.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Christian Subbio, MD · Answer

Only your doctor can answer whether or not he or she will charge you for a revision.  Everyone does it differently.Best of luck!
Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Daniel Barrett, MD · Answer

Dear tthomas75,every plastic surgeon has his own policy regarding revision surgery so it would be the best to check it with your plastic surgeon. Most surgeons ask the patient to pay for anesthesia and surgical facility fee. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Tim Sayed, MD, MBA, FACS · Answer

Without photos it's hard to say what the cause of your perceive bottoming out is. If it's an overly dissected lower pole of the breast or lowering of the fold that occurred, you may have a crease in the lower breast causing a double bubble or you may simply have a long lower pole, which may be correctable by fixing the fold back to its proper position. If the implants are large and have stretched the lower pole skin, I disagree with one of the authors here in that sometimes you DO need skin removal - that of course depends on whether your breasts had significant ptosis (overhang) before the original procedure or not. Some patients can get a nice looking result with implants alone even when they are candidates for a subtle lift, whereas others may end up having their implants stretch the lower breast skin and result in the whole breast looking too low, even if the nipples are pointing forward. Other patients will end up with their implants looking high but their NATURAL breast tissue bottoming out. As you can see, the solution definitely depends on:1. Where is the implant in relation to the nipple and breast tissue2. Where is the current inframammary fold and did it move from where it was originally (either by direct intent of the surgeon or by effects of the pocket/skin being stretched)3. How much skin is there between where the fold belongs and where the bottom of the implant currently sits?As for costs of revision, your surgeon most likely provided you a revision policy with financial responsibilities outlined. Most surgeons will still need you to pay a facility and anesthesia fee (these are real costs to do the surgery which the surgeon does not fully control), even if the surgeon elects (though is not obliged) to offer you a discount or waive the surgeon fee. Obviously if you go to a new surgeon - which you may want to do depending on your individual circumstance - you would be paying the new surgeon's fee.

Lisa Cassileth, MD, FACS · Answer

Bottoming out has two main causes... the first, your surgeon overdissected the pocket and it is too low. This can happen quite by accident, especially with big implants, as they are hard to fit in, and then when it finally adjusts and relaxes it is too low although it looked perfect at the time of surgery. If this is why, it's pretty obvious they are too low within weeks of surgery. These boobs are a quick fix with a capsullorrhaphy stitch. The other (and worse!) reason is that you form a too thin capsule and the implants dissected their way down to your abdomen. These cases usually have a very movable implant, the implant goes way out to the side when you lay on your back, and it takes several months for the problem to show up. These cases need REAL support with ADM and an internal bra as a capsullorhaphy stitch won't work. And Never let a surgeon cut out skin to make the problem better... the implants go right back to their saggy position and now you have a huge scar. No!

Gilbert Lee, MD · Answer

Sorry to hear about your bottoming out problem.  My suggestion is to have a sincere face to face discussion with your surgeon.  Most surgeons are very reasonable and want you to have a nice result.  Typically patients will have to cover the cost of Anesthesia and Operating Room costs.  However, when both parties participate in an open dialogue, usually a very acceptable outcome is reached.

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast augmentation surgery.  Policy regarding coverage of expenses for revisionary surgery will vary from office to office and probably on a case-by-case basis as well. Costs of revisionary surgery may range from zero, to anesthesia/surgery center fees, to discounted surgeon's fees.It will also be important that you feel comfortable that your plastic surgeon has a significant/demonstrable experience helping patients with this type of revisionary breast surgery.Best wishes.

Kimball M. Crofts, MD, FACS · Answer

You should check with your surgeon about his revision policy.  Typically some surgeons will charge a revision fee within the first 6-12 months after surgery to cover costs of the return to the operating room.  You will likely need pocket reduction surgery to get the implants back up into position.  In some settings patients will also need to place Strattice which is a biologic tissue matrix to support the implant internally.

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