What Should I Do? Bottoming out Implant? (photo)

I've had implants for about 10 years. 2 ruptured and replaced. Always had a problem with my left breast hanging lower then the right. It has been bottoming out for about 6 years and it is incredible uncomfortable but I do not have the finds to fix this problem. I am saving up to do so. What is my best option?? Remove and replace with smaller implants or remove implants all together. I would love to have some scar revision done on my nipples too so they look a little more normal.

Doctor Answers 9

Breast implant and lift issue

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More information and an exam in person are required to properly evaluate you. It looks like your left breast ( right in photo) is hanging lower than the opposite side. You may need a lift. If you have ample breast tissue, then you could have the implants removed if you are ok to being smaller.

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Bottoming Out After #BreastAugmentation

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From your photos it does appear that you have malposition of the implant on the left and significant asymmetry. You would likely need a combination of procedures to fix this. You should have an "intern bra" type procedure where the capsule is tightened to help place the implant in the proper position. Smaller implants will place less weight on the internal repair. Then you would need to have the breast lift tightened to help improve your symmetry as well as scarring.

You should see a board certified plastic surgeon experienced in revisionary breast surgery to get a formal opinion through and in-person consultation.

Best of luck,

Vincent Marin, MD

San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 52 reviews

Bottoming Out

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Fortunately, you have many choices. Although you've had a run of bad luck with implant ruptures, and your left breast has dropped out/causing discomfort, I don't think it's time to throw in the towel and quit. The non-problematic breast looks quiet nice, and there is no reason you can't get it to look even better while getting the other up to speed too.

If you like your size, you could keep your current implant size. It is true that a smaller implant size will improve the longevity of the results of any revision you undertake, though. Regardless, the scar capsule surrounding your implant will need to be sewn up along the bottom and outer border to decrease the cavity's size and allow it to support the future implant into a higher, more medial position. Doing this usually alleviates the pain associated with low lying implants. I would also convert to silicone gel if you haven't already; the likelyhood of early rupture (with in the first ten years) is low, and the potential impact and subsequent tissue stretch is less than a comparably sized saline device.

Next, a revision mastopexy should be performed that would address all the issues including persistent glandular sag with a long distance between nipple and inframammary fold, a square breast shape on the left, asymmetric areolar shape and size, and asymmetric size of the breasts. In order to achieve all that, your vertical lift (I see no inframammary scar) should be converted to an anchor scar, which will allow the most tightening and best shape improvement.

This may sound like a lot, but this is routine for surgeons who perform revision surgery on a regular basis. Visit a few that are certified by the ABPS, and are members of the ASAPS. Look at their photos and then decide.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Breast implant and lift - Los Angeles

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The good news is you have many options. An examination will help determine whether a revision breast lift or a lift with implant exchange or removal is best.

Raffy Karamanoukian Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Internal bra for recurrent bottoming out breast implant

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When implants and/or breasts sag after two operations for the problem, the tissues (meaning mostly the skin envelope) have demonstrated that they are too weak to hold the repair. For that reason an internal bra should be considered. This can be done with acellular dermal matrix such as Strattice, or newer biocompatible materials such as SERI scaffold mesh.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Breast revision

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Size is a personnel choice - if you wish to be smaller then have your mastopexy revised with smaller implants or none at all - clearly though the left breast looks larger then the right and that should be corrected at your next surgery.  Please chose a surgeon with lots of experience with redos to avoid future problems

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 65 reviews

What Should I Do? Bottoming out Implant?

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I think that a change to smaller implants along with a breast lift and attention to areolar symmetry would be a reasonable choice.

Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast augmentation revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD Los Angeles, CA

What Should I Do? Bottoming out Implant? (photo)

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The left breast shape inferiorly is the issue. I might revise via an inferior inverted T incision to try to re shape the breass.

Implant & breast bottoming out.

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Hello Crisycat- If most of your breast is implant versus tissue, then replacing the implant in your next surgery is probably optimal. Most importantly, an internal (capsule) and external (dermis and skin) lift would be beneficial. The internal lift refers to sewing the capsule up and inward as much as possible while still creating a normally positioned lateral and lower breast fold. The external lift refers to redoing the skin lift (mastopexy) with care to use the de-epithelialized dermis as a sling along your lower breast curve. The circumference of your areolae can be made more symmetric at that time.  Take care to view many revision and breast lift photos when choosing a surgeon.  Good luck.

Mark Anton, MD, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 38 reviews

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.