How to Fix Slight Bottoming out Due to Over-dissection?

It's been 8-9 months since my BA. From the first day of surgery my left breast was always bigger and lower. Can you please tell me how my doctor can fix my breasts unevenness? If he fixes the left breast by stitching it up to raise it, will that last? Will it reoccur again? I have been very unhappy and now worried that fixing the left one is no guarentee. So should I have him fix the left one or the right one to make then even? Which way is the right way to fix my problem? Please advise.

Doctor Answers 12

Inferior capsulorrhaphy

This is a very straight forward fix for plastic surgeons who specialize in revisionary breast surgery. It would require an inferior capsulorrhapy (suturing the pocket) and a mirror image superior capsulotomy. I have written two papers on this topic. The surgery takes about 45 minutes and the recovery is minimal.

Del Mar Plastic Surgeon
4.9 out of 5 stars 39 reviews

Breast Asymmetry after Breast Augmentation

It is almost never possible to have complete and absolute symmetry after breast surgery, especially if you have asymmetry prior to surgery. Having said that, you can always have your breast infra-mammary fold raised with a revision breast augmentation surgery such as capsuloraphy. You need to know that this revision will not guarantee to completely correct this asymmetry since scarring during the healing period can affect surgical outcome.

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.4 out of 5 stars 49 reviews

Repair of the bottomed out breast implant

You photo shows very clearly the low breast implant on the left side, with the point of projection below the nipple, the left nipple appears higher than the right. The pocket is 'over dissected' and because the cause is evident, repair of the fold is the correct solution. If we were to get fussy, the left implant could be a bit smaller as well, though the repair of the fold should be stable and effective, and fix your problem.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

How to Fix Slight Bottoming out Due to Over-dissection?

Dear peach75,

I am sorry to hear about your concerns. The left breast inframammary fold appears to be a little low, causing the implant also to sit low. A breast implant revision with capsulorraphy to raise the inframammary fold should fix the problem. I would discuss your concerns with your surgeon.

Warmest wishes,

Larry Fan, MD

Larry Fan, MD
San Francisco Plastic Surgeon
4.3 out of 5 stars 14 reviews

Correcting breast asymmetry

The left breast fold appears lower than the right which also makes the distance from the fold to the nipple longer on that side. Corrective surgery to raise the left fold is possible through a number of techniques. Manipulating the current capsule about the implant and essentially placing the implant in a new space yields good results. There are also dermal grafts which can be used to recreate/restore the fold to the desired position.

I would encourage you to return to your surgeon and discuss your concerns and options. If your concerns are not adequately met seek out a board certified plastic surgeon for a second opinion.

I hope this was helpful and good luck.

Robert W. Kessler, MD, FACS
Corona Del Mar Plastic Surgeon
5.0 out of 5 stars 129 reviews

Asymmetric folds under the breasts


If there is asymmetry of the folds under the breast they can be improved with either suturing inside the pocket or on occasion a material can be used called acellular dermal matrix (Strattice) but it is not typically required for a first time repair. I would discuss your concerns with your plastic surgeon where you can come up with a plan together. It does appear to me that elevating the left fold will give the best aesthetic result.

I hope this helps

Dr Edwards

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 35 reviews

How to Fix Slight Bottoming out Due to Over-dissection

Breast revision surgery is performed for a number of reasons and factors related to the patient’s initial breast surgery. One reason is #asymmetry.

However, there's no guarantee the #asymmetry will simply be resolved with one breast revision. There are various reasons breasts can appear uneven or asymmetrical; which have to be taken into account when your surgeon determines the appropriate approach and technique for your #revision surgery.

Typically, it's best to wait 6 to 12 months depending on the reason for #revision.  As with all cosmetic surgery, results will be rewarding if expectations are realistic. With any surgical procedure, there are some risks which your doctor will discuss with you during your consultation.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Lift the left...

It’s not unusual for patients to note implant malposition in the immediate post-operative period.In many cases, this is transient and related to swelling and muscle spasm.For this reason, revisional surgery should be delayed for at least six months following surgery. Prior to this time, corrective surgery involves trying to hit a moving target because wound healing is such a dynamic process. At six months, skin tightening, muscle spasm, swelling, and the inflammation associated with wound healing have improved sufficiently to obtain a good result.
Your left breast implant has drifted downward and needs to be lifted in an upward direction.This will require a procedure known as a capsuloraphy.This procedure involves placing sutures in the lower breast pocket to raise the height of the inframammary fold.This procedure provides correction of the problem and is associated with high satisfaction rates.
If you’re concerned about implant malposition, it’s important to consult your plastic surgeon.Your surgeon should be able to formulate a plan that addresses your concerns.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Bottoming out of left breast implant

It should be possible to fix your problem with a relatively straightforward procedure known as a capsulorrhaphy, in which sutures are used to reinforce the bottom of the breast.  The capsule should also be released in the upper portion of the breast, so that there will be a roomy pocket for the implant.  In difficult cases I uses material such as acellular dermal matrix to reinforce the repair, but it is usually not necessary for the problem that you have.

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 reviews

Bottoming out correction

I would suggest repair of the left inferior breast capsule with permanent internal sutures (capsulorrhaphy). This involves removal of a segment of breast implant capsule among the inferior/lower aspect of the left breast implant pocket. The 2 edges of  capsule tissue are sutured to one another with permanent suture. This procedure reduces the size of the implant pocket and prevents the descent  of the implant on the left side. This procedure will improve the symmetry of the breasts  and the positioning of the nipple–areola on the left breast mound.

Make sure you're working with a well trained experienced board-certified plastic surgeon.  Capsulorrhaphy, even in the best of times, is not always successful in further revisionary surgery may be necessary.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.