Am I sagging and am I a 34D? (Photo)

Question

I had my BA done April 29 2015 so it has been 3 months and I feel that they are sagging. Everyone is telling me I'm crazy but I think they have. I had high profile silicone with 550 cc and I was a 34a going for a D which I don't even feel like I am. So am I sagging and at a 34d.

William Andrade, MD · Answer

Hello, over time implants can descend lower than their original position, then the nipple looks relatively high on the breast mound.  This is called "bottoming out" - perhaps you are noticing this change over time.  Regarding your bra size, this is hard to determine from photos but you can have proper bra fitting to determine this.

Marc Pacifico, MD, FRCS(Plast) · Answer

Many thanks for posting your questionFist of all, it appears that your breast size is around a D cupHowever the issue that I see is one of bottoming out - it appears that your breast implants are sitting a bit low in the breast. Is this what you mean by sagging?If so, and it bothers you, then revision surgery might be required.The best thing would be to discuss with your plastic surgeonGood luck

Sheila S. Nazarian, MD · Answer

It does appear that you are bottoming out.  You probably had smooth implant placed.  There are newer textured silicone implants that resist dropping like that.  I recommend you switch out.  You may need a breast lift as well during that procedure.

Christopher J. Morea, MD · Answer

Thank you for your question and providing photos. Based on the photos provided it appears that your implants have inferior displacement. I would recommend you discuss this and your concerns with your surgeon. Best of luck

Nelson Castillo, MD · Answer

Thank you for your photographs and questions. I am sorry to hear about your disappointment with your breast augmentation surgery, but I can see your reason for concern.  It appears that your breast tissues have stretched with time causing your implants to settle too low on your chest, or bottom-out.  Unfortunately this can only be corrected with a revision surgery to tighten the breast pocket.  In order to help prevent this from occurring again you may want to consider reducing the size of your implants and/or using an internal bra for additional support. Talk to your surgeon about your concerns, they can help walk you through your options.

Don W. Griffin, MD · Answer

You are not sagging as much as your tissue has stretched and your implants are sitting too low on your chest. This is known as bottoming out and is more common with implants that are large for a patient's frame, with high profile implants in tight skin envelopes, and with saline implants, but it certainly does occur with silicone as well.At this point, surgical correction is the only option to improve your shape. The goals of the procedure are to tighten the pockets, reinforce the tightening with artificial material like SERI mesh or ADM material and possibly going to a smaller volume implant. The mesh reinforcement is necessary because there is a high recurrence rate when the pocket is tightened without reinforcement. The weight of the implant and the thin nature of the tissue cause the sutures to pull through and the pocket re-enlarges. The mesh has greatly decreased the chances of the pocket enlarging again, but it still does occur sometimes.

Mathew A. Plant, MD, FRCSC · Answer

It appears as though you are bottoming out, not sagging. There is a slight difference between the two but in either case if you are 3 months out and unhappy for any reason you should talk to your surgeon. Hope that helps!

Joshua Cooper, MD, FACS · Answer

Your breast implants appear to be fairly large for your frame, and the weight of these implants has caused stretching of the lower portion of your breast skin.Therefore, your nipples appear too high, and your implants appear to low.   We call this "bottoming out."Definitely meet with your plastic surgeon to discuss options to repair this. Thanks for sharing!

Adolfo Sesto, MD · Answer

Thanks for posting your question in this site, and also for entrusting your photos.I do understand what you are experimenting. Even though  your implants  look nice, they  are getting down to the lower pole. All you need is to ask your surgeon to close the pocket in its inferior part,  and this will do.Good Luck.

Tom J. Pousti, MD · Answer

I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are  appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”).
It is probable that you are feeling the implants significantly along the lower poles of the breasts. Patients in your situation often complain of discomfort in the area of implant malposition. Also,  consistent with the breast implant positioning problem, the nipple areola complexes seem to be sitting relatively high, because the breast implants have settled too low.  
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.
Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery. 
I hope this, and the attached link, helps.

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