Have my implants bottomed out again for the second time? What can I do? (Photos)

You had one of the most difficult breasts in primary mammoplasties a surgeon can meet in his career: combination of extreme grade of tubular or constricted breasts plus severe breast ptosis (droopiness).

These cases have a high rate of reinterventions or retouches.

Your surgeon has done a fabulous work, he needed a touch up at the lower pole and now you can feel lucky with the result. You never had bottiming out and neither have it now.

Only enhancements envisionable are enlarging breast fullness with brodear and anatomical shaped implants, and if excessive mobility is a problem for you then consider the biovelcro of the polyurethane coated implants.

I am not being corporativist, it is a realistic advice.

Dear meli_mel,

bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.

Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.

If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.


Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

You need smaller implants and a revision of the old scar. You may want to consider fat transfers to create more upper pole fullness.

Best Wishes,

Gary Horndeski, M.D.

Thanks for your question! It doesn't necessarily look like they have bottomed out. The breast has stretched. If you aren't already, I would recommend sleeping in a bra and being in one as often as possible. Good luck!

Sadly, there are no simple non-surgical "fixes" for this problem. Should you decide to have it redone in the future, ask your surgeon to discuss the use of one of the "internal brassiere" techniques, where the weight of the implant is supported internally, using a construct such as Alloderm or Stratttice, rather relying solely on the skin and breast tissue to hold the implant weight.

To get the implants to stay in place the augmentation has to be done in a way where there is tissue support to hold the gravitational pull of the implant.
This can happen if the pectoralis muscle is transected to aggressively or if the IMF (infra mammary fold)has been opened up during surgery.
Correcting this so it doesn’t recur it can be tricky and not all plastic surgeons have good track records with it.
The correction is typically done using internal permanent sutures with or without mesh.
You should get second opinion in person consultations with other plastic surgeons in your community.
Bring all before and after pictures and all operative reports with you.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of previous cases of patients with the same problem.
Ask the provider how many Bottom out implant revisions they’ve done and what their success rate has been
As the surgeon if this happens after their own breast augmentation?
Ask the provider what the most common reason for revision surgery is, what their revision rate is and what their revision policy is
This will continue to recur until the repair is done correctly.
If you don’t know who to consult with and consider finding the plastic surgeons who do most of the breast cancer reconstruction in your community.
They often have extensive breast surgery experience, especially with complex difficult situations.
I’m sorry this keeps happening to you.
I know it can be very frustrating.
Provider selection is the most important variable.
I also recognized at finding the right provider is really difficult.
My best suggestion for finding the best surgeon is to interview lots of them and try to push them to get a sense of how much experience and what their success rate has been.
People usually know when they are talking to an exceptional plastic surgeon.
There are also those were very charming, but technically don’t do great work.
Surgeons are responsible for surgical outcomes and patients are responsible for who they choose to go with.
There are significant differences among different plastic surgeons.
Best,
Mats Hagstrom MD