1 year after subfascial breast augmentation and breasts have dropped significantly. Am I bottoming out? (photo)

Question

I had a subfascial breast augmentation one year ago. For months I have felt that they "dropped" a lot, one side more so assuming because of my anatomy. Am I bottoming out? Does it seem like a normal amount of "settling"? Incisions are not in my crease either.

Randal Haworth, MD, FACS · Answer

Hello !

It doesn’t look like they are particularly bottoming out but it looks like your breast sag due to stretchy skin and weakened tissues. 
Fortunately, it can be fixed with a tissue matrix (like Strattice) to support the tissue and hold your breast pocket in the desired location.

I hope this helps,
Best of luck !

Randal Haworth

Semih Yildiz, MD, FEPOBRAS · Answer

The visible photo suggests lower-pole fullness and some downward settling, but bottoming out cannot be diagnosed reliably from one view alone. It is judged by measurements: where the implant sits relative to the breast fold, whether the nipple appears too high on the mound, whether the nipple-to-fold distance has stretched, and whether the fold has moved lower.

At one year, most settling has already occurred. If the implants continue to sit lower, one side has changed more, or the incisions are no longer in the crease because the fold has shifted, it is reasonable to be evaluated for implant malposition or bottoming out rather than assuming this is normal settling.

Correction, when needed, usually involves revision of the implant pocket, reinforcement of the lower fold, possible capsulorrhaphy/internal support, and sometimes changing implant size or profile. Bring your early post-op photos and current photos to your surgeon or another board-certified plastic surgeon so they can compare the breast fold and implant position over time.

Daniel Barrett, MD · Answer

Dear Abcdefghiklmn,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

It doesn't appear from your photos that you are necessarily bottoming out, but the breasts do appear somewhat ptotic.  I encourage you to visit with your surgeon to discuss your concerns and learn more about your options.

Shana Kalaria, MD · Answer

Hi there, It looks like your breast implants have started to fall below the fold/IMF (bottoming out) which has caused the incision to rise. You don’t necessarily need to get this fixed as it is mild, but if you want to there are techniques that can be done during surgery to fix this. Good luck!

Connie Hiers, MD, FACS · Answer

You did not show your before photo, but I suspect one breast sat somewhat lower than the other. You don't appear to have bottomed out as of yet. However, please discuss your concerns with your surgeon.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.

Based on your photographs I do not see evidence that you have bottomed out.  Based on your photographs I think your result looks appropriate with an equal distribution of volume above and below the nipple areola.  Typically with bottoming out the distance from the bottom of your areola to the crease under your breast enlarges and too much skin is seen below the nipple areola.

The fact that your incisions are not in the inframammary crease is not visible on the front view thus based on your appearance I would not intervene surgically.

1 year after subfascial breast augmentation and breasts have dropped significantly. Am I bottoming out? (photo)

Answers (7)

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