Are my implants bottoming out and should I consider more surgery? (photos)

I am 13 weeks post op from an augmentation mastopexy. have 350cc subglandular mentor silicon moderate plus. I had significant pstosis pre op and almost no breast tissue of my own. I now have excess skin again on the upper pole of my left breast and it seems saggier than I thought it would be. I have seen my PS and she has said that it would seem that I have stretchy collagen and my results are a dramatic improvement but they are saggier than they should be. second opinion wanted

Doctor Answers 8

Are my implants bottoming out and should I consider more surgery?

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Thank you for your question and photographs, and I am sorry that you are disappointed with your results.  Based on the stretch marks on your preoperative breast tissue picture, it appears that your skin has poor overall elasticity and tone.  This can be due to either genetics, or can be the result of fluctuations in weight.  Despite the likely removal of a significant amount of skin at the time of your operation, your skin can not support the weight of your implants and they are causing your skin to stretch.  Your breasts will continue to change over the next several months, but i would recommend you look into an internal bra surgical procedure with replacement of your implant into a below the muscle position.  The internal bra will take the weight of the implants, and your remaining breast tissue, off of your skin and allow for the best aesthetic outcome.  Hope this helps.

Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

About Healing Post Augmentation and Capsular Contracture

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Bottoming Out is the term given to implant displacement, where the implant drops down below the existing inframammary fold (natural crease beneath your breast). This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants end up sitting very low on the chest and there is lack of internal support for the implant itself. Correction usually involves restoring the crease beneath your breast to its normal position. This involves internal reconstruction including the capsule around your implant (capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix) can be used to attach to the breast tissue internally and support the implant. This corrects the placement of the implant, redefines the breast shape, and refines the internal fold.However, it's still early in your healing process. #Healing will continue for 2-3 months following your #Augmentation #Mastopexy procedure. There may be some swelling, bruising, malposition, color differences. Sensation will be abnormal. Scars will also be changing.
But, it can be up to one year see your final result. Your doctor may require you to move or massage the implants within the breast pockets during the #postoperative period. #Textured implants do not require breast massage. You will be informed about this at your post-operative visit.
Also, the two breasts commonly heal quite differently so #assymetry is not unusual. One breast may swell more, feel more uncomfortable, or have a different initial shape. After complete #healing, they will be more similar and natural. You must have patience, but if this causes concern, ask questions of the doctor or the nursing staff.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

You are fine

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Your are doing well.  I see no issues.  This look is normal look for someone who started with your starting point. Your surgeon did good job.  

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 24 reviews

Are my implants bottoming out?

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Based on your preop photos, you appear to have a great result! Your tissues appear thin and probably do stretch more than normal so you may need another lift, along with scaffolding/support material (i.e. Strattice, Seri) for the lower pole of your breasts sometime down the road. For now, enjoy your new shape!

Are my breasts bottoming out. Do I need more surgery?

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I think you have an excellent early result considering where you came from.  The degree of ptosis you had before surgery indicate that your tissues are very stretchy, and some moderate sag is inevitable after one procedure. Your implants are in good position. You could be relifted some with further skin tightening after 6 or more months to let things fully settle, but I think this is more due to a limitation of the elasticity of your tissues rather than a procedure that was not done optimally. Your breasts look nice, are dramatically improved, but yes they could be lifted further if you desire it are willing to undergo additional surgery.  I would wait another 3 months, and discuss your options with your surgeon.   With your current breast size, and size of implants, some breast hanging below the fold is natural and unavoidable, but the nipples could be repositioned superiorly and some additional lifting could be done.

Lift revision

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Chances are your implants are not far from where they should be.  This of course would depend on what you would like your breasts to look but also on seeing your breasts from the side profile.  I suspect that what you really would benefit from is a lift revision, raising and tightening the breast skin.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Left breast skin saggy after an augmentation

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It is difficult to evaluate the thickness and resiliency of skin from a photograph.  Only having limited information, it does seem that your plastic surgeon is correct that your breasts do appear much better.  I would wait a least one year to get a better idea of the extent of the sagginess and whether there is a difference between the two sides. 

Elliott B. Lavey, MD
Danville Plastic Surgeon

?Bottoming out

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Bottoming out occurs when the implant descends below the breast fold, lifting the fold off the chest wall. The photo posted would not show that--side views are needed.  But I suspect the problem is not that, but that more of a lift might have given a better result. I would suggest a fairly minor revision, elevating the areolar about a centimeter, decreasing the areolar size, and more skin tightening using a lollipop incision approach.

I do agree that the improvement is dramatic and that the breasts are saggier than they might be.

All the best.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.