I had revision surgery to fix bottomed out implants. Have they bottomed out again? How can this be fixed? (Photos)

Question

I originally had a breast lift with implants over a year ago. 3 months later they started to bottom out. I had revision surgery done to fix this and i fear it’s happening again. Are they bottoming out? Is there anything i can do to stop it bottoming out more?

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

Hi, thanks for your question. Yes, it does look like your implants may again be bottoming out. You can reduce the risk of this occurring by wearing a supportive bra during the day and at night. Revision surgery could be considered but would not be straightforward. You could consider downsizing your implants, having the implants removed all together (and consider fat transfer to augment volume), using a mesh as an ‘internal bra’ to support the implants, or a combination of these techniques.

Daniel Barrett, MD · Answer

Dear melinaz17,

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

Ira H. Rex III, MD · Answer

From your photographs, it seems that the implants and breast tissue are in relatively good position and you have a very nice result.  If your result is stable at this point, you may have many years of good breast aesthetics.

Michele A. Shermak, MD · Answer

Hello! Thank you for your question.
Everyone has a unique footprint of their breasts on their torso. Yours do sit on the lower side which is something you cannot change. It's part of your anatomy.
Your implants do seem to be settling. This could be related to your skin being able to support the implant, whether it be due to your intrinsic skin quality, possibly also the weight of the implant. Options would be to improve support with a mesh, like Galaflex, and/or reducing implant size.
Hope this is helpful for you. I would recommend you seek guidance from a board certified plastic surgeon near you. You can find one at plasticsurgery.org.

Karl William Schwarz, MD · Answer

It does look like the implant is moving down and it makes your nipples start to move up. You naturally have a wider breast and I have found over the years that patients with wider breasts are more challenging for implants and have a much higher rate of re-drooping.

When I suspect someone is going to be what I call a "rapid re-drooper" which also includes descent of the implant I plan on doing a revision at 12 months to get rid of the redundant skin and tissue and sometimes it is required more than once.

I would advise you to wait until you have experienced most of the re-drooping (which takes about 12 months) before going back to the operating room for a revision. I tell patients to give it a year so that we can then remove all of that weak skin and tissue. I have found that revising it too soon doesn't stop the process and you have to do it again anyway so it makes more sense to me to wait until most of the re-drooping has happened and then remove all of this skin and tissue at once.

I also use mesh or Strattice on all of these patients from the beginning to help support the implant.

Camille Cash, MD · Answer

It does appear that your implants are bottoming out.  This can be seen by the nipples pointing upwards and the inframammary fold moving forward.  Correction would include another revision.  To prevent it from occurring again you can consider smaller implants and/or adding bioabsorbable mesh to support  your breast tissue.  I've included a video I hope you find helpful.

Sean Fisher, MD · Answer

yes, it appears you have asymmetric implant positioning with the left sitting considerably lower than the right side. Implant malposition can occur for a variety of reasons including implant selection, tissue quality, and pocket position. For patients that have had recurrent issues with implant malposition, I often will recommend incorporating a combination of capsule tightening (Capsulorrhaphy) and tissue support with some type of mesh product depending on the specific surgical needs. Ultimately, what needs to be done surgically depends on your anatomy and the problem. For some patients, this means requiring reinforcement of the breast fold while others have excess stretch of the lower pole of the breast and need offloading with a internal bra support. Consult a well-qualified plastic surgeon who can give you recommendations based on an in-person exam.
Sean Fisher Aesthetic Plastic Surgeon Seattle, WA

Mats Hagstrom, MD (license on probation) · Answer

Correcting bottom out implants is not easy or straightforward.
The chance of this situation is highly dependent on how the initial augmentation was performed.
Implants that are placed under the pectoralis muscle usually require the pectoralis muscle to be transected to a certain degree.
Over resection of the pectoralis muscle can cause the implant to lose its support against gravity creating a bottom doubt implant.
Ideally enough pectoralis muscle needs to be left intact to hold the weight of the implant.
This also requires not violating the infra mammory fold during surgery. 
Perhaps a bit technical but there is a reason some patients develop bottomed out implants and others don’t. It’s generally a surgical technique issue though there is also some variation in patient candidacy as well. 
You should confirm your surgeon has extensive experience correcting this deformity.
Ask them to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar situations For whatever condition you are having treated.
Ask provider specifically what their repeat revision or success rate has been.
Correcting bottomed out implants is generally done using internal sutures with or without mesh or cadaver dermal products like Alloderm. 
Best,
Mats Hagstrom MD

I had revision surgery to fix bottomed out implants. Have they bottomed out again? How can this be fixed? (Photos)

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