5 1/2 months post op - Am I bottoming out? Lateral displacement? (Photos)

I have sientra 440 HP silicone implants. I'm having pain in L breast when I do anything more than stand upright. Left is dominant. This started 3 weeks ago and escalated in the last 3 days. I am also unhappy with how far apart my breasts sit. When I lay down I go completely flat chested. I also have weird indents, by my sternum. my PS did specify that because of the way my chest wall is built, my implants would sit farther apart naturally. But I can't have my boobs disappearing.What can be done?

Doctor Answers 3

Is this bottoming out?

Your breast implants do sit low, but this may be a product of your initial anatomy and presentation. Your preoperative photo seems to indicate that you were on the verge of needing a breast lift. You should talk to your plastic surgeon to understand their expectations and consider what may be helpful to get you your best results.


Fall River Plastic Surgeon
4.6 out of 5 stars 44 reviews

Augmentation results not perfect

but a lot depends on what you and your surgeon discussed.  You were marginal to start with (bottom heavy) and a lift could have benefited you I often will suggest that the augmentation be done first and then decide if the lift is needed.  Then it comes to placement of your implant... by your natural fold, ideal nipple position, or some other agreed upon position?  With the fullness of your lower pole, it appears that you are bottoming out but has this changed from your early post-op appearances?  If the distance from your fold to your nipple is getting longer, you're bottoming out and will need a revision to correct this.  Since you are looking at possibly returning to the OR, you should decide if you want your lateral pockets also diminished since the recovery from elevating folds is quite demanding and requires your full compliance.  Discuss your concerns with your surgeon to see what options are provided to you.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Am I bottoming out? Lateral displacement?

I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are  appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”). Based on your description and photographs, it sounds like you are experiencing lateral breast implant displacement as well.

 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 will 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 and laterally.  In my practice, this repair is done with a 2 layered permanent suture technique. The use of acellular dermal matrix is an option (although not usually necessary)  especially if significant implant rippling/palpability is present. Associated issues with positioning of nipple/areola complexes should improve with this operation.


Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery.  

I hope this, and the attached link (you will find separate links devoted to bottoming out as well as lateral breast implant displacement concerns), helps.

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.