Am I bilateral bottoming out? Asymmetry? Both? Lateral displacement? (Photos)

Question

Iam almost 5 months post op, i have 600cc under the muscle on both breast, i belive something is wrong with my breast they dont look just right, my right seems too low with no upper pole, it sticks too much to the out side, and my left still seems high and smaller than the right, do they look normal? Or should i consider a revision?

Jed H. Horowitz, MD, FACS · Answer

Yes , your breasts are asymmetric.  but revision is a personal decision.  Large breasts are heavy and will drop with time and gravity.   Revisions do not guarentee no future problems.  Breasts without implants  change and sag over time

"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.
It is best select a plastic surgeon who is #board-certified and has a great deal of experience with breast #augmentation and the incision type, #implant placement, and implant type. Plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your breast augmentation. Aside from checking board-certification, it is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Gerald Minniti, MD, FACS · Answer

Hello,One of your breasts sits lower and more to the side than the other.  Both are low and to the side, partly because of your implant size, and partly because you probably had breast ptosis prior to surgery. Best of luck!

Scott Chapin, MD, FACS · Answer

I would need a little more information to help you with your issue.  First, your pre op frontal view [straight on] photo would be helpful.  That would show me whether you had a significant asymmetry pre op.  Sometimes people notice their natural asymmetry post op if they are not alerted to it prior to surgery.  If your right breast was lower and off to the side more so than the left pre op, then this would be an expected result.  My hunch is that your right implant has lateralized or migrated to the side.  This can best be seen from a supine [lying down] photo.  You'll need to have someone take this photo for you.  You should lie down with your arms at your side, and have the person [hopefully someone you know!] take the photo from your feet almost level with your chest.  You'll see the right implant going off to the side if you have lateralization.  This usually occurs with the use of smooth implants.  If you have smooth implants and lateralization, you would need a revision with placement of a textured implant and the popcorn technique.  You can see a video of the popcorn technique on my website.  I currently use textured implants for first time breast augmentation patients to prevent this problem.

Humberto Palladino, MD, FACS · Answer

Breast revision will solve your problem. You will need a lift and some support for the implant since is a large size and your skin tends to stretch. Since your implants are quite recent you can use the same implants. This way you will recover a more permanent upper pole fulness.

Tyler C. Street, MD · Answer

You should only consider revision if it bothers you.  Your right implant does look a little low, lateral, and the right breast may be slightly larger than the left.  Asymmetry is normal in breasts.  If you did proceed with revision, waiting a little longer may be smart.

Am I bilateral bottoming out? Asymmetry? Both? Lateral displacement? (Photos)

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