Bottomed out immediately after surgery, - is effective breast revision possible? (photos)

Question

Dear doctors, implants are Motiva Ergonomix Demi smooth, round 285cc bilaterally, dual plane placement. My height is 160cm, weight 49kg, 43yrs old. Have bottomed out immediately after surgery, breasts are too wide and flat, deformed contours and dissecting constrictions to outer and inner breasts. BW: R13/L10.9. Breasts are droopy, side profile very unattractive, indentation b’ween upper breast and upper rib, wide cleavage. Can revision help? Anatomical or round? Can mastopexy be avoided? Thx

Brian Bassiri-Tehrani, MD · Answer

This is a good question for a complex problem. A revision should be able to address your concerns of having bottomed out implants, breasts that are too wide, with visible implant rippling in the upper pole/part of your breasts. A breast lift (mastopexy) should not be needed to address those issues.
To address this, a mesh (off-label) can be placed as an internal bra to help support your breasts and implants to prevent your implants and breasts from bottoming out again. The mesh is bio-synthetic and is bio-degradable - it is not permanent, and will resorb over time. To address the rippling, a highly cohesive implant can be placed (Mentor Boost is a good option, this is a round smooth silicone implant). Additionally, fat grafting to the upper part of the breast can be done to further prevent visible rippling. Fat grafting can also help give a more natural result and shape while adding a mild amount of volume. Hope this helps!

Randal Haworth, MD, FACS · Answer

I’m sorry your breasts augmentation didn’t go as planned. Revision surgery may be an option to address these concerns. During a revision, the implants can be adjusted or replaced to improve the shape, position, and overall appearance of the breasts. Whether anatomical (teardrop-shaped) or round implants are recommended would depend on your specific goals and the advice of your plastic surgeon. An « internal bra » would be placed inside your breast for additionnal support. (Strattice). A thorough physical examination is needed to assess whether a breast lift is necessary at this point.

I hope this helps,
best of luck !

I hope this helps,
best of luck !

Richard Baxter, MD · Answer

You don't need a lift, but your tissue envelope is very thin which results in very little support and coverage for the implants. An internal bra with Galaflex or Strattice is the solution. You don't need different implants.

Ira H. Rex III, MD · Answer

I'm not sure how long ago you had your surgery, but it is usually best to wait at least six months before considering any revision. The shape will surely change over time and as things heal, the scar tissue around the implant develops and sometimes allows for a better ability to shape the implant pocket.

Anna Steve, MD · Answer

Yes! Bottoming out can certainly be fixed without a breast lift. The breast fold that would usually support the implants in the correct position can be reconstructed with a tool called an internal bra. The type of bra I used most commonly is made of the same material as dissolving stitches and is replaced by a strong layer of your own collagen. This can support the implants back in a better position. This can also be combine with fat grafting to soften the aesthetic lines and improve the shape of your implants.

Chul Hwan Seul, MD, PhD · Answer

Mastopexy does not seem to be necessary, and it would be better to close the enlarged implant pocket to raise the position of the implant a little higher, and to narrow the cleavage while making the outline of the implant less visible by grafting fat around the implant. It seems to be improved with this reoperation, and it seems to be okay to just use Motiva implants.

Daniel Barrett, MD · Answer

Dear Antibes23,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

At this time, I recommend removing the implants, repair the dual plane muscle, if possible. Then wait 6 months and then perform a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Karl William Schwarz, MD · Answer

You don't need a master Pasi, but what I would do is perform fat grafting into the breast to help with the rippling and reestablish where the memory fold is with some mesh and sutures to get the implant restored to the correct position as well as excise some of your skin along your breast crease to remove that redundant skin.

Jeremy Powers, MD · Answer

I’m sorry you’re having these issues after breast augmentation. The good news, even though it would require more surgery, is that revision can definitely be done to fix this. The final surgical plan would depend on review of your medical history, prior operative report by your first surgeon, and physical examination. But there are two options that I would consider - 1) implant replacement with conversion to subfascial plane and breast fat grafting or 2) hybrid breast augmentation with implant replacement, lower pectoralis muscle sling, and breast fat grafting (as described by Prof Munhoz in São Paulo). Round implants can still be used if supplemented by fat grafting.

Bottomed out immediately after surgery, - is effective breast revision possible? (photos)

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