Implant size and bottoming out? (Photo)

Question

Hello, I'm getting a second boob job done to fix bottoming out. I am stuck between whether to go 295cc or 325 cc - soft or a more harder implant. I currently have 250 cc under the muscle and want to go bigger. Which size would you advise? I am 5"2, 7 stone but feel my size of 250 isn't big enough as I have to wear padded bras.

Michele A. Shermak, MD · Answer

Hello!
Implant increase depends on your size goals. It is best to discuss with your surgeon. I would find the match to the 250cc that allows for an increase in projection.
You need to be careful as weight of the implant may contribute to thinning of tissues and bottoming out. I would strongly suggest you get support for the lower breast and address both sides. Galaflex is my favorite product for this. Will help limit recurrent bottoming out particularly with larger implants.

Daniel Barrett, MD · Answer

Dear Unknown28,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

In terms of implant size, if you are size 32 or 34, each 100 cc of implant corresponds to 1 cup size change. If you are size 36 or 38, each 200 cc of implant corresponds to 1 cup size change. From this, you can determine the volume required to achieve your desired goal. You only need the plication performed on the lower breast. You will need inferior plication done at the time of implant exchange. You may also benefit from circumareola approach to move the nipple-areola complex more centrally.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Charles Chalekson, MD · Answer

Hello Unknown28.
There is not much difference between 295cc and 325cc, so lean in the direction you would rather err in. If you are worried about choosing too small again, go with the 325. If you want to make sure your implants are not too large, go with the smaller size. I typically recommend at least a 20% increase in size to notice a difference. Firmer might allow for a little more cleavage, but if you are young with good skin tone and not much natural breast tissue, the softer implant might be fine for you.

John L. Burns Jr., MD · Answer

You need to have your breast crease/inframammary breast crease reconstructed to give you the same nipple to fold distance on both sides.  I'd suggest using Mesh support such as Galaflex or Durasorb to prevent recurrence.

Ram Kalus, MD, FACS · Answer

Needless to say, an examination in person would be required to properly evaluate you and determine your best treatment options. That said, I would allow your surgeon to make the determination as to which implant is most likely to optimize your symmetry. It appears that you have some native anatomic asymmetry and if you trust your plastic surgeon, he or she should be able to hopefully help you accomplish to your goals. Your expectations need to be realistic and perfect mirror image symmetry is probably not realistic but hopefully you will be pleased with the correction. Best of luck to you.

Camille Cash, MD · Answer

Especially in your case it is important to be careful with the implant selection.  The weight of the implant can cause it to bottom out.  You may want to consider adding mesh for further support.  That being said, going from a 250cc implant to 295cc will provide only a conservative increase in size.

Connie Hiers, MD, FACS · Answer

If you are bottoming out with 250 cc's, I would not go much larger unless your surgeon supports this weight with mesh.  Most women bottom out from getting an implant that is too heavy for their tissue.

Mats Hagstrom, MD (license on probation) · Answer

Simply, correcting a bottomed out, implant is difficult on its own. This is a complex procedure that requires being on the hands of a sufficiently experienced provider in order for the condition, not to recur and ending up with a high quality outcome.
Adding larger implants increases the chance of recurrence, and I would be careful pushing the envelope until you’ve got the implant pocket stabilized, long-term without showing recurrence of the implant bottoming out. Correct in this condition is usually done either using internal permanent sutures and sometimes reinforcing either using mesh or cadaver dermal products like Alloderm.
To minimize the chance of this happening again, and again, you should be very careful in who you select to do the Revision Work.
Make sure they have a proven track record of doing this correction successfully with an impressive collection of long-term before and after pictures showing competence.
Revision Work tends to be much more difficult and complex than primary breast augmentation. This is especially true for managing implants that have bottomed out.
Plastic surgeons should be careful to not violate the inframammary fold, and should be careful in opening the pocket inferiorly, and the chance implants bottoming out is made worse by choosing larger implants.
Consider having multiple consultations before scheduling revision surgery to make sure you’re in the hands of the most talented and experienced provider, or at least a plastic surgeon who has a proven track record of correcting this deformity
It is not easy or straightforward.
Good luck,
Mats Hagstrom, MD

Implant size and bottoming out? (Photo)

Answers (9)

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