I am bottoming out. Will internal sutures fix this even though I want to go up in size? (photo)

Question

I am bottoming out. My left side is worse. I have 350 cc HP saline filled to 375. I am getting internal sutures in March and also going up in size. (500 CC HP silicone). If I am going bigger, will the implants be more likely to bottom out again?- or if it will be ok since I am getting internal sutures. I am worried they will continue to drop. Should I expect them to drop even more? Is it a better idea not to go up in size and just get internal sutures? Thanks for the help!

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 and any visibility of the inframmammary fold scars 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.

Ryan Neinstein, MD, FRCSC · Answer

Tough call, sutures work but they are not a guaranteed solution and now you want to add a weight on the sutures. It is possible but is somewhat risky, decide what is most important to you and work with your PS to make the best possible decision, GOOD LUCK

Douglas Leppink, MD · Answer

The problem with "bottoming out" relates to a lack of sufficient support for the weight of the implant. There are internal ligaments (Coopers ligaments) that are woven throughout your breast gland that act like a "cargo net" to support the weight of the implant. If this support is compromised then your implant will drop due to a lack of support. The internal sutures are placed to repair the support, but going larger will stress your ligaments and repair even more and I fear that the problem will return.

Darryl J. Blinski, MD · Answer

Yes I see the "bottoming out... Best to either internal suture cappsularraphy or ACDM implantation or both. Increasing size could cause the issue to return...

Steven Wallach, MD · Answer

If you have bottoming out, then sometimes it is advised to actually place smaller implants back in with the capsule repair. I would refrain from going bigger.

I am bottoming out. Will internal sutures fix this even though I want to go up in size? (photo)

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Answer: I am bottoming out. Will internal sutures fix this even though I want to go up in size? (photo)

Answer: I am bottoming out. Will internal sutures fix this even though I want to go up in size? (photo)

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I am bottoming out. Will internal sutures fix this even though I want to go up in size? (photo)

Answers (8)

Answer: I am bottoming out. Will internal sutures fix this even though I want to go up in size? (photo)

Answer: I am bottoming out. Will internal sutures fix this even though I want to go up in size? (photo)

Answer: Fixing pocket and then adding larger implants?

Answer: Fixing pocket and then adding larger implants?

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Recommended reading

Everything you need to know about Breast Augmentation

Our mission is to create a world where every investment in modern beauty is Worth It.