I Think I Have a Leak As Well As Bottoming Out!? (photo)

I am 1 yr 9 months PO and my left breast seems to be shrinking! I know that I have bottomed out but my left keeps getting smaller but very slowly. Please someone let me know if it looks like a leak.

Doctor Answers 11

Breasts Different Sizes with Leak and Bottoming Out

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    The different sizes could be due to a slow leak from a saline implant and bottoming out on the other.  If the left breast is hardened at all, this could be capsular contracture.  Kenneth Hughes, MD breast implants Los Angeles, CA

Asymmetrical Breast After 1 yr & 9 months Post-op

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Thank you for sharing your photos.

It is a little difficult to provide you a definitive explanation to why you are exhibiting breasts asymmetry at this point without analyzing your pre-op photos as well as the full details of your surgery.

Nonetheless if your implants are saline instead of gel, a possible leak may be considered. Also, you may be loosing left breast tissue at a faster pace than the right one or it could be possible that the right breast is bottoming out at a faster pace than the left one hence the noticed asymmetry in the photos.

At this point, I would encourage you to consult with your surgeon who will be able to assess your current situation since he/she knows the full details of your surgery and can provide you with a physical examination.

I hope this helps and thank you for your inquiry.

The best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Rupture vs Bottoming Out?

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The photos shared demonstrate that you had some asymmetry preop with the right nipple and breast being lower than the left.  The use of implants that are larger than what would typically be recommended for your frame has accellerated the bottoming out as well accentuated the pre-existing breast asymmetry.  The breasts look fairly similar in size and may feel different due to asymmetry in implant position.  The body absorbs the fluid from a saline implant fairly quickly so it will be obvious if you have a rupture. Silicone implant rupture is more subtle and requires an MRI.  Consult your surgeon for further input regarding your concerns. Best Wishes!

George Bitar, MD
Fairfax Plastic Surgeon
4.6 out of 5 stars 59 reviews

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Asymmetry after breast augmentation

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Your pictures show that the implants are too big for your frame, both in terms of volume and base diameter.  The volume asymmetry can be due to a number of reasons, including loss of breast tissue, change in implant volume, or fluid and swelling that is persistent in the right breast.  I would recommend a Board Certified Plastic Surgeon for an opinion.  My recommendation would be for removal of the implants you have now and replacement with implants that are better matched to your body size.

What knid of implants you have?

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Your breast are uneven and without before picture it is hard to say if it is due to the implants or breast tissue asymmetry.Your implants are too big for your breast tissue and bottoming out is expected. Saline implants will collapse completely if there is a leak.

Kamran Khoobehi, MD
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#BottomingOut after #BreastAugmentation

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From your photos, it is clear that the left breast is smaller than the right, but I'm not sure to what extent this has always been the case as the left breast was smaller from the beginning. It does appear that both implants are bottoming out to some degree as they look somewhat different than the 2 month photos - this may be contributing to the different appearance of the left breast. Also, you could be experiencing a leak from the left side, but this cannot be determined from the photos alone.

You should see a board certified plastic surgeon in your area 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
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Slow leaks are very uncommon with saline breast implants

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If you do have a saline rather than a gel implant, slow leaks are an exception, as most experience a sudden and impressive volume loss over days time and not much longer. A gel implant will not lose volume with a leak, though can become tight and firm or tender. It doesn't look like a leak, but see your surgeon to help sort things out.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Progressive breast asymmetry

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A physical exam is the only way to know for sure what is exactly happening with your implants. Saline implants generally do not show slow leaks. It is possible, but very uncommon. A more common reason for slowly developing changes with breast implants is capsular contracture formation. This usually manifests itself with hardening of the implant, whereas slow leaks would make the implant feel softer than normal. Have your surgeon take a look and give you his/her opinion. 

I do think that the right implant is starting to show signs of bottoming out. Your implants look a little big for your body frame in my opinion and will be prone to malposition with time. You may require a pocket revision at some point or even a breast lift if the implants are given time to stretch out the skin envelope. 

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
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Leak As Well As Bottoming Out!

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The right side fits the criteria for bottoming out. I am less certain about why the right side appears smaller. If it is saline, slow leaks can occur but they are uncommon, and usually represent not a whole in the shell but a problem at the level of the valve. It it is silicone, it would seem unlikely that there would be a size change that is noticeable with a small leak. Imaging studies (MRI) are the gold standard to diagnose a silicone leak, but the procedure costs about $2000 and is usually not covered by insurance. If you are going to have a procedure anyway for the bottoming out, it would be more cost effective to make an incision at surgery and determine whether or not there is a leak and proceed from there.


Thanks for the question, and for the photos attached, which are very useful. Best wishes. 


Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Breasts Implant Leakage?

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Your  left breast certainly does seem smaller compared to the right side ( after comparing photographs). It is possible that you have a slow leak. Of course, direct physical examination by a well experienced board-certified plastic surgeon will be your best bet to receive good advice.  Direct palpation of your breasts implant  will be helpful in determining whether it is inflated or slowly deflating.  You may also experience increased rippling of the  breast implant in the event of leakage.

Other  conditions can potentially cause breast asymmetry.  For example, sometimes breasts can appear to change in size or position on the chest wall  if an encapsulation (capsular contraction) process is present. 

Again, in person consultation with a board-certified plastic surgeon will potentially be very helpful.

Best wishes.

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.