My surgeon says there's nothing wrong and that I've got to get a second opinion, am I bottoming out? (Photos)

Question

I am 3 months post op and my concerns are that my implants have bottomed out so I have been to see my surgeon today and he has said there is nothing wrong. I had a breast augmentation and mastopexy on 18th October but I developed an infection so I had to have emergency surgery to remove the dead skin and breast tissue on 23rd November 2020. I know that my nipples appear to be too high and I can feel the implants at the bottom. Please can you advise me, thank you

Kevin G. Rose, MD · Answer

Thank you for your questions and photos. Based on the position of your areolas it looks like you have some implant displacement. I would recommend pocket tightening and fat grafting and PRP to the breast to improve the cleavage distance. Hope this helps and best of luck to you.

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

Hi, thanks for your question. The appearance of your nipple being too high is because it is not sitting over the most projected part of the implant. This could be improved by shortening the distance from the bottom of the areola to the fold beneath the breast, reinforcing this, and also considering repositioning the implants so that they sit higher on your chest. An additional technique to consider to improve the appearance would be fat grafting to the upper pole.

Donald R. Revis Jr, MD · Answer

Good morning!
You really do need to have your pockets fixed to have a nice result- you have a significant amount of bottoming out, which is why you have no upper pole fullness and your nipples are higher than your implants. I recommend the Original Internal Bra, my strong permanent internal suturing technique, which moves your implants to the correct position and supports them there over the long term. I first developed this technique 20 years ago, and today it is the most common revision I perform, 5-6 times a week- it works and it lasts!

Riaz Agha, MBBS, DPhil(Oxon), FRCS(Plast) · Answer

From the photos this appears to be the case. This is why your nipples are sitting high and the upper pole appears deflated. Over time, the effect of gravity and further loss of support could make this worse. It would be best to get a second opinion in person and also discuss again with your first Surgeon. Good luck.

Kenneth Hughes, MD · Answer

Bottoming out involves the implant moving below the inframammary fold over time without causing two distinct folds. Sometimes this is the result of weak patient tissues, too large an implant, or a combination of both. The repair involves suturing the pocket with capsulorrhaphy sutures and possibly adding an acellular dermal matrix for reinforcement (Alloderm, Strattice). The implant size may need to be reduced as well. Schedule a consultation with another board certified plastic surgeon for a second opinion.

Gary M. Horndeski, MD · Answer

Yes, your implants have bottomed out. The weight of the implants exceed the mechanical strength of the skin envelope. After 6 months from the date of surgery, you will need a revision. You may need smaller implants and excess skin removal.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Bright97208,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ram Kalus, MD, FACS · Answer

Thank you for your inquiry and photos. The good news is that your nipples are not "too high" in relation to your chin, but you do have breasts that are relatively low on your chest with a relatively long distance from your collar bone to your nipple. So you are partly right that your breasts don't look quite right, especially with your arms raised, and that is because they are what we refer to in plastic surgery jargon as "bottom heavy", meaning that the distance from your nipples to the fold at the bottom of your breast is longer than desirable, and therefore your folds need to be raised, as do your implants, the bottom of which indeed determine the location of the fold. The correction is not difficult, but it does require additional surgery. Your surgeon may indeed feel that you are being picky but lest we forget that our goal is always a happy patient, and you are apparently not altogether happy, you should communicate your concerns to your plastic surgeon. If he or she cannot be persuaded, you always have the option of a second opinion. Select a board certified plastic surgeon whose aesthetics seem to align with your own. Best of luck to you.

Scott W. Vann, MD, FACS · Answer

Your implants are definitely too low relative to your nipples. Either this happened slowly since your surgery by stretching which I would call bottoming out of the implants. Or maybe there was too long of a vertical scar which means the implants were too low all along due to the long nipple to breast fold distance. Either way you need a revision to expand the upper pocket to let the implants move up, and shorten the vertical scar by adding a horizontal incision in the breast fold. Get  in person second opinions if necessary. Good luck.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  It appears that you do have some bottoming out taking place but this is best ascertained with an in-person examination and I would recommend seeking out second opinions.  Best wishes.

My surgeon says there's nothing wrong and that I've got to get a second opinion, am I bottoming out? (Photos)

Answers (12)

More Breast Implants Questions

Interested in breast augmentation and trying to determine if I can get by without a lift, any suggestions? (Photos)

Eczema and breast implants: does having eczema put me at risk for breast implant illness?

I am about an A cup (32A or 32AA) and desire a small C cup. Is 300cc enough to achieve that? (photos)

Will 325 cc be too big? (photos)

Breast implant size- 250cc silicone low profile, any suggestions? (Photos)

What would 800-900 cc look like on someone who is 5’9" and 155 pounds? Is this too much?

WE SEND PRETTY
EMAILS