Am I bottoming out? Do I need a revision? (Photo)

Yes, you are bottoming out which appears as if your nipples are too high. Once the inferior pocket is corrected, the nipples should be in the correct position. If you have a revision, new implants are usually used. since you are bottoming out, I do not recommend going larger which will be a heavier implant. You might need mesh for support.

At this time, I recommend removal of the implants, fat transfers and revision of the lift with possible a transverse component to use the excess breast skin from the bottom to transpose higher on the chest wall. Remember implants are not lifetime devices and fat transfers are permanent.

Best Wishes,

Gary Horndeski, M.D.

It seems like your skin envelope has stretched out.
Based on your before pictures, I think you are predisposed to having breast skin that stretches easily.
Needing to re-tighten the skin envelope after a breast lift is not uncommon.
It’s hard to tell where your implant position sits
Bottomed out implants have to do with breast positioning not so much with breast skin envelope.
Unless the implants are old plastic surgeons often use the same implants during revision surgery unless there’s an indication to change implants like if you want to go bigger.
Selecting excessively large implants will increase the chance of undesirable, side effects, Increased complication rates and increased need for revision surgery.
It seems like your implants fairly conservative so I think going up slightly should be fine.
Follow up with your plastic surgeon.
Best,
Mats Hagstrom MD