I had my revision bl/ba in Oct 2010 (my 1st bl/ba was in 5/2010). My Left implant sits higher up & protrudes more than the right (300 cc). My right implant (210cc) feels like it is in my armpit (but very low). I don't even know why I have an implant on that side because it does not give me any upper pole fullness which is what I wanted. Also, I do not have a crease on the right side. Does it look like I have bottomed out?
Have my Implants Bottomed out?
Doctor Answers 13
Yes, you have "bottoming out."
Your first breast lift plus implants was 10 months ago; your revision was 5 months ago, and now you have recurrent bottoming out. BTW, "bottoming out" is not due to "heaviness" of your implants, as they weigh 7 ounces and 10 ounces respectively. Your breast skin has somewhat less collagen and elastic fiber content than others, which is (partly) why you needed a lift in the first place. It is reasonable to anticipate even more "bottoming out" as more time goes by, and your scars fully mature over a year or longer. Thus, this will not "get better" by simply waiting. If you are unhappy now, you will only become more unhappy, so platitudes that "things will get better" are untrue in this case.
All that being said, your surgeon has given you a nice result with good volume, shape, and nipple position symmetry between your breasts. But, you're unhappy with your lack of upper pole fullness, and your inframammary crease not matching your mastopexy scar (on the right side, by your description), and your right implant dropping too far to the lower armpit area when you are reclining.
Here is what I observe (thanks for the photo--always helpful): Your inframammary flap length (lower edge of areola to inframammary scar, not present crease) is about 8 or 9 cm in length (hard to tell exact measurement from photographs) or longer; this needs to be around 5.5 cm as this can be expected to stretch (especially in you). The whole inframammary scar should be excised (both sides) and the pockets tightened with internal sutures. The present "rage" is to use dermal matrices (such as Strattice) to reinforce the crease tissues and help provide support to this area, which is not a bad idea in patients such as you who have less dermal density and more stretch. However, sutures alone, or a modified Ryan approach can also accomplish this quite nicely without the high cost of the dermal matrices. Your implant pockets may need to be opened slightly (superior capsulotomies) to ensure that the higher inframammary crease will not cause excessive tightness in your pockets. Superior capsulotomy will also help provide more upper pole fullness as the implants are elevated towards your infraclavicular area. If the lateral pocket on your right side allows too much implant movement towards the side of the chest (lower armpit), this can be closed off slightly (capsulorrhaphy) for improved symmetry.
Your surgeon does good work; but is he or she taking into account what time and tissue healing and stretch do to your results? If you look great right after surgery, isn't it an error to not take into account how you will look in the long term, especially second time around? I tell my patients I'd rather have them look a little "high and tight" initially--that way when things drop, soften, and settle (they ALWAYS do), then there is a BETTER chance for a long-term good result that stands the test of time! Get another opinion if you don't believe your surgeon can accept this strategy! Best wishes!
New reconstructive procedures offer better results
Over the last five years I have been using various materials to support the lower pole of the breast, as well as the lateral portion of the pocket, for breasts that have developed malposition. The problem of a breast "bottoming out" has been greatly improved with the use of dermal matrix grafts including Alloderm,Strattice,and Biodesign. These materials come in sheets and are sutured along the inside of the pocket, to add a reinforcing layer to help support the breast implant. I have also use them to correct the problem of breast implants coming too close together over the sternum (breastbone) as well as to correct visible rippling particularly with saline implants.
Bottoming out after augmentation
In my opinion, your breasts actually look acceptable in this photograph given that yours is a revision augmentation. Issues of asymmetry are challenging to solve and would be helpful to have your before pictures so that I can better compare and contrast the changes. A lot also depends on what your expectations are and what you discussed with your surgeon before the surgery.
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Breast lift with augmentation and bottoming
Unfortunately this is what I just referred to in response to another breast question. Combining mastopexy (lift) with augmentation using implants results in an increase in complexity, a decrease in predictability and control over results, and an increase in revisions. There is also no simple way to judge how much bigger one breast is compared to the other and a difference of 90cc's between the two sides is enough to cause dimensional and contour problems as well.
Analyzing and recommending correction is too difficult to be done from a single distant photo. And although the odds aren't as bad as revising rhinoplasty multiple times, the potential for making a simple correction and having that solve everything may not be possible and you will have to accept the result with the limits of your tissues.
It doesn't help much since you can't go back and start over and this isn't a bad result as several have pointed out but the key is to surgically alter or adjust as few factors as possible and try to maintain the most control over the outcome. This looks like a situation where a proper mastopexy done with a lollipop incision should have been done first and then the result assessed for the need of an augmentation. Perhaps an assessment of the size and position of the implants along with a tuck of the lower poles and adjustment of the inframammary crease could be done to improve the result.
Your implants and breast tissue together are too heavy for your skin to hold them up. Some descent is to be expected. This is not really bottoming out technically as the implants do not appear too low and your nipples are in good position. This is breast tissue by the look of your image.
John Di Saia MD
Breast augmentation and lift
It looks likeyou have perfectly natural results. The scars are still red and may take some more time to settle down.
Some assymetry is expected after any breast surgery given that breasts are never absolutely symmetric. It is fairly difficult to see if you have some bottoming out from the photos.
When a breast implant has bottomed out
Actually based on the photos you have sent, your result looks even and natural. You do have a longer distance from the nipple to the fold under the breast which is an indication of why the breast lift may have been needed. An implant has bottomed out when the center or projecting point of the implant is below the nipple, not the situation I see in the photo. Give yourself time to adjust.
Best of luck,
You have a beautiful result.............
The question shouldn't be what our diagnosis is, it should be are you happy with your new breasts? You have a beautiful result! Your scars aren't finished healing yet, and when they are, the results will look even better. I would suggest wearing a supportive bra to prevent recurrence of the drooping you previously had.
Bottomed out breast implants
Dear Lilly, Without seeing a side view and without knowing the nipple to inframammary crease distance, it would be hard to tell. If the left crease is higher than the right and the distance from the nipple to the fold is longer on the right you probably have bottoming out. It also sounds like you have a capsule that is too large for the implant. This may be why you feel like the implant is under your arm.
See your plastic surgeon as there is a procedure to correct this problem called the a capsulorraphy. You may also need some Alloderm or Strattice to help support the repair. These are tings to be discussed with your surgeon. Depending upon when your last surgery was, I would probably wait at least 3 months after that before planning any further surgery. Good luck, Dr. Schuster from Boca Raton.
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