Need second opinion! Am I bottoming out? Should I be worried about my incision? 9 weeks postop 520cc HP smooth round (Photo)

 Thank you for the question and photos. From what I can see in the photos I agree with your plastic surgeon. Certainly if you have any additional questions or concerns I would urge you to contact your surgeon. Good luck and congratulations

From your photos alone, it is difficult to accurately answer your question. At nine weeks, there is still some residual swelling, and the implants have not completly settled. While your left breast implant does appear lower than the right, this may due difference in initial placement, or the right implant not have settled completly. With regards to the incision, it would appear to be superficial based on your pictures alone, and should close. Follow your surgeons instructions regarding wound care. Any implant position differences still present after three months will probably require surgical correction.

Hi 02Butterfly,

Thank you for the question and the photo. I understand your concern.

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.

Though rare, some women who undergo breast augmentation will develop a minor deformity known as a “double bubble,” in which additional folds appear underneath the breasts due to the implant accidentally shifting or contracting post-surgery. In most cases, the implant simply slipped too far down the chest wall and traveled behind the breast inframammary crease (the area where the lower breast meets the chest), instead of moving forward to fill the breast cavity. If left untreated, the lopsided implant will form unnatural indentations, resulting in an odd “four-breast effect” rather than the full, rounded chest the patient initially desired.

However, you are still in the early stages of the healing process at 9 weeks post op. Your will need to be patient at this moment and follow what your surgeon has instructed you to do post operatively.

At the early stage of the healing process, the tissues around the implants are still swollen. Once the swelling subsides and the implants drop to their final position, you will be able to see the final result of your breast augmentation surgery. It can take about four to six months for the implant to drop down to their final position. Also, your breasts can drop at different rates.

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, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

No, you have no bottoming out.  Your scar is hypertrophic but should settle down with time. Share your concerns with your surgeon and get their recommendations on how to get your scar to improve.

Seems you are over reacting! There is NOOOOO bottoming seen in any of your posted photos. As for wound edge issues can not respond via the internet, why not pay for in person secnd examination opinion from another boarded local PS?

Hi and welcometo our forum!Congratulationson your recent surgery. I'm sorry that it has been rough going with the healing delay. The photos you provided appear to demonstrate a degreeof asymmetry. There does not appear to be an infection. You do not appear to be bottoming out.  The wound appears clean and should seal in a short period of time.The process of breast healing after augmentation involves remodeling of thesoft tissues as the "drop and fluff" phenomenon occurs. One breastmay fall into position faster than the other over a span of 3 months or so.  I recommend thatyou continue followup with your surgeon, allowing more time to heal(usually 6-12 months).  If required, a minor revision will correct theproblem.Bestwishes...

Without having the opportunity to examine  you in person I must support your chosen Plastic Surgeon to give you the best opinion after your regular follow up  evaluations. Continue to do what might be recommended, and if you have any doubts, get a second opinion in person.Good luck to you!Frank Rieger M.D.  Tampa Plastic Surgeon