About Breast Implants Bottoming Out
"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.
To manage scars following the procedure, I suggest #scar maturation products to my clients. Such as BioCorneum or Embrace, to name a few, are recommended. But, it's best you wait a few weeks following your surgery, to begin using them and speak to your surgeon about healing concerns.
Your breasts look great right now. That being said, your left breast does look like it bottomed out. That goes well with your history or revision surgery with release of the left breast base. Revision surgery should shorten the distance from your left nipple to the inframammary fold and even out your nipple/areolas.
Best of luck.
It would be nice to see your breast shape before surgery. I think overall they look nice. Yes there is some asymmetry, but this may be within normal limits.
From your photographs as well as a history of having the left breast lowered, it's my opinion that it is now bottomed out.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 just 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.