Why do my implants keep bottoming out? Twice it's occurred. What is the solution?

Question

Richard Baxter, MD · Answer

If you have had a recurrence of bottoming out after a repair with internal sutures, then you will need a different approach to correcting it. The skin and breast tissues have shown that they are not strong enough to support the implants, so the addition of internal support with something like Strattice is needed to reinforce the support.

Craig S. Rock, MD, FACS · Answer

I'm sorry to hear about the problem you have been experiencing.  There are many potential causes for bottoming out.  Some possibilities include that your implants are too large for your frame or your breast tissues do not have enough strength to support the implants used.   Why it recurred following revision would depend upon both the cause and the method used to try to correct the issue.In general, revision of the scar capsule would be required, as well as the possible use of an acellular dermal matrix or mesh to add structural support.  If the implant is too large for your frame,  a decrease in implant size may also be required.I would recommend that you consult with board-certified plastic surgeons experienced at performing breast augmentation revisions.  After reviewing your history (including previous operative reports, if available) and performing a physical exam, the surgeons should be able to provide you with options to correct the problem.Best wishes.

Tom J. Pousti, MD · Answer

I am sorry to hear about the complications you have experienced.  Online consultants will not be your best resource when it comes to helping you determine specific causation of the recurrent breast implant displacement problem.  As you know, much will depend on exactly what type of revisionary breast operation was performed.  Ultimately, you will likely be best off seeking in person consultation with well experienced board certified plastic surgeons who can demonstrate lots of before/after photographs  helping patients with this type of revisionary breast surgery.  A review of your previous operative reports would be helpful.
  Generally speaking, revisionary breast surgery to correct  breast implant bottoming out involves capsulorraphy (internal suture repair).  I have found that the use of a two layer permanent suture repair is most effective in my hands, when it comes to long-term correction of breast implant position.Sometimes, depending mainly on the patient's history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh. 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. 
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 and video (dedicated to corrective surgery for bottoming out concerns), helps.

Cain R. Linville, MD, FACS · Answer

This is a tough problem - once the IMF has been distorted, you will need something stronger to hold it in place and prevent recurrence.  The thing I like to use most is Strattice, which has a lot more strength than Alloderm, and doesn't stretch over time, making it ideal.  But, there are some others to consider, like Galaflex.  Anyways, you need at least this internal sling/bra, and maybe even more.

Why do my implants keep bottoming out? Twice it's occurred. What is the solution?

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Answer: Bottoming out

Answer: Bottoming out

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Everything you need to know about Breast Implant Revision

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Why do my implants keep bottoming out? Twice it's occurred. What is the solution?

Answers (4)

Answer: Bottoming out

Answer: Bottoming out

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Recommended reading

Everything you need to know about Breast Implant Revision

Our mission is to create a world where every investment in modern beauty is Worth It.