Bottoming Out, Bigger Implant?
You are clearly bottoming out on one side and appear to have a bit of a double bubble. The other side is not as bad but there is a hint of a double bubble there as well. Putting a larger implant in will not solve the problem and has the potential to make it significantly worse if nothing is done to reinforce the internal capsule and reposition the implant to a higher level. A larger implant is heavier and will have an increased risk of bottoming out. If your concern is that you don't have enough fullness in your upper breast then the first step in correcting the problem is to reposition the implant.
Am I bottoming out?
From the looks of the
photograph, it does appear that you have a small amount of bottoming out. Bottoming out occurs when the implant
migrates inferiorly and drops below the natural inframammary fold. It appears that your breast implants are at about
the lowest point that they should go.
However, I do not think that your bottoming out would necessarily
require surgery at this point. If you do
desire to have bigger implants, it would be possible. It certainly looks like you have the skin
envelope to accommodate a larger implant.
Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inflamamatry fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.
What are you trying to accomplish
with larger implants? The others have said you are bottoming out. Without seeing your pre-op photos, your results could be very good as imperfections sometimes have to be accepted to achieve the volume of breast that you desire. This would be your nipple position and bottomed out appearance. If your fold is now stable, and you're really not that unhappy with your size, fat grafting alone could help round out the bottoms when viewed from the front. So try to figure out what you really want here, let your surgeon know, and allow your surgeon to provide you options from which you can choose.
Bottomed out breast?
When a breast implant migrates below the
original placement location with the bottom of the implant just above the
infra-mammary crease, we call this “bottoming out.” There are several causes of
this downward migration of the breast implant. Usually, some attempt had been
made to lower the crease to accommodate a breast implant whose base diameter is
larger than would otherwise fit in the natural breast. In doing so, the
anatomic attachment of the skin of the breast to the chest wall can be
obliterated. There is then nothing to hold the implant up. With the weight of
the implant, and constant gravity, maybe lack of support by lack of wearing a
bra continuously, the implant can settle downward. One of the earliest
symptoms, I see in patients seeking revision,has been the feeling that the
breast has to be constantly adjusted or just feels heavy. We look for the
incision line, which was previously placed at the crease, to have migrated
upward onto the breast. When we see this early on in the postoperative phase,
it will never get better with time and will require a secondary repair. While
some plastic surgeons may rely on suturing techniques only, I have found that
unless we un-weight the implant by making it smaller or strengthen the tissues
below by making them less stretchy, that the same implant, with just sutures placed on the bottom of the
pocket, will, over time, recur it's bottomed out position. I have used part of
the capsule as well as the lining of the deep muscles and tissues over the ribs
in the capsule beneath the breast implants to rotate upward to hold the breast
implant in a higher position and therefore obliterating the extra space that
has been created between the correct infra-mammary crease and the one created
by the downward displacement of the implant. I call this a three flap technique,
as the skin, the capsule and fascia (lining of muscles), as well as a dermal
flap all contribute to creating a hammock like support of the lower portion of
the pocket. When these tissues are insufficient to hold the implant up, or a
previous attempt has been made with sutures, I will oftentimes rely on the
addition of another type of tissue called an acellular dermal matrix of which
my preference is Strattice. This Strattice ,or pigskin, does not stretch and
can be sewn in to the bottom of the new location of the crease to support it
just like a hammock would. Although this is costly, I consider this an
insurance policy against having to redo this again. I would recommend that you
try and find a plastic surgeon with experience in revisionary cosmetic breast
surgery. Good luck.
Yes you are bottoming out, that is why your breasts are bottom heavy with a very low inframammary fold, and little upper pole fullness. Bigger implants is not the answer. You'll get your upper pole fullness back with a revision surgery to close the pockets down with permanent sutures and possible a mesh sheet to support the capsule repair.
If your surgeon is not an ABPS certified/ASAPS member surgeon that specializes in revision surgery, you should interview a few.
Best of luck!
500 cc implants bottoming out?
I feel that going to larger implants is not the right answer and would not consider that for my patients. The weight of your current implants and their size have likely contributed to your implants dropping down and IMO you should have them repositioned with capsulorrhaphies and possibly replaced with smaller implants.
Get a few opinions from face to face consultations. Best wishes.
Jon A Perlman MD FACS
Certified, American Board of Plastic Surgery
Extreme Makeover Surgeon ABC TV
Beverly Hills, Ca
You have both bottoming out and double folds currently. I will recommend both capsule sling and tightening of the folds
Your photos indicate the implants are bot asymmetrically positioned and sitting too low for your anatomy and whether that comes from a surgeon trying to lower the fold or just from heavy implants, you will need internal repair called a capsulorrhaphy to recreate the fold and center the implants behind the areola. Getting bigger implants is not the answer.
Am I bottoming out after breast augmentation?
I think your concerns are appropriate; your breast implant does seem to sit somewhat low on your chest wall, consistent with breast implant displacement ("bottoming out”).
Also, consistent with the breast implant positioning problem, the nipple areola complexes seem to be sitting relatively high, because the breast implants have settled too low.
I think you may benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation. I would suggest that you reach a long-term stable weight, if you are not there already prior to undergoing additional breast surgery. I would also suggest the use of capsulorraphy techniques, especially if you are planning on the use of larger breasts implants.
In my practice, this type of repair involves a two layer, permanent suture repair (reconstructing the inframammary fold areas). Sometimes, depending on the clinical situation and history, the use of additional support materials such as acellular dermal matrix or biosynthetic mesh is also helpful.
Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with this type of revisionary breast surgery. Key will be: your surgeon's experience level, careful execution of the procedure, careful attention to postoperative care/activity restrictions.
I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.