Implants Bottoming Out - Strattice vs Removal?

I'm in my early 30s & have had 250cc submuscular implants for 6 years. The surgery damaged my nerves from day 1, but the results were aesthetically beautiful for 5 years. Over the past year, I've developed rippling & bottoming out. I can see my scars, & my left breast feels heavy. The heaviness is upsetting to me & I'm wondering about 1. Strattice or 2. implant removal. Does anyone have feedback on the average outcome & cost of these procedures? Any feedback is appreciated.

Doctor Answers 10

Implants bottoming out after 6 years--What to do?

I'm glad to hear you had a great result for the first 5 years, but it sounds as if your tissues have stretched some (allowing the downward drop and "bottoming out" appearance), and your implants now have less tension on them, causing the visible rippling. Deflation of your saline implants is another possibility that can cause increased rippling, but complete deflation usually occurs, and rarely in both sides. So it's likely your muscle and skin have simply stretched over time, your implants have dropped (allowing the scars to now become visible), and ripples are more evident.

Without seeing you, the recommendations are still the same for this situation. I would recommend switching to the latest generation of cohesive silicone gel implants as these almost always solve the ripple problem, and if not eliminating all of it, make it significantly better. You have inframammary scars (since you can now see them), and I would use these same scars to access the pocket and perform inferior capsulorrhaphy (suture elevation or tightening of the pocket) to raise your inframammary creases. I would recommend slight "over-correction" as time, healing, and scar stretching (as has occurred over 6 years) will cause your pockets to drop somewhat again. This will help to give you a long(er) lasting result. Slightly larger implants can also help fill out the loose(er) skin, if you wish. Otherwise, tightening and lifting the pocket can be accomplished with sutures alone, or reinforced with dermal matrices (such as Strattice). These add another layer of density to the thinned tissues near your creases, but also add significant cost. Neither way of raising the creases can be honestly "guaranteed," and each surgeon may have his or her own opinions about which option works best for them in the majority of cases.

The "heaviness" you feel in your left breast is difficult to explain on the basis of what you have told us, especially as the implants weigh the same (unless they leak) as they always have. I suspect the dropping of the implant position makes the appearance more of a "heavy" or sagging look, but the actual weight should not be changed, though your subjective appreciation of heaviness can indeed be very real. Smaller implants would only reduce the weight by an ounce or two (not noticeable), but as you move to smaller implants you will have a narrow base diameter for the pocket base diameter, causing more "rolling around" or side-to-side movement that is unnatural. Be careful; it's not just about size (volume), it's also important to check dimensions. Best wishes!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Cost for Revisionary Breast Surgery

You will find many different answers depending on who your ask.  Cost will vary depending on many factors.... first of all it differs depending on if a board certified plastic surgeon is performing the surgery or not.  Also, if the surgery is performed in a hospital based operating room vs. an office setting, if a board certified anesthesiologist is involved vs. a nurse (or sometimes performing procedures under local anesthesia), etc.  Please be careful when doing your research to make sure your surgeon is properly trained and has experience in this procedure.  In San Diego, the range can be $6000-15,000 depending on what is performed, what type of implants are used, if a breast lift is needed, if AlloGraft is used, etc..

Ask to see examples of the surgeon's work and talk to other patients who have undergone this same procedure to hear what they have to say.

Good Luck!

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,485 reviews

Strattice for bottoming out

Once your tissues become to thinned to support the weight of your implant, the best solution is to reduce the weight of the implant (resize or remove) or increase the support. Strattice is a good solution. The base cost starts at around $2600 for the smaller pieces (probably large enough for your 250cc implants).

Nia Banks, MD, PhD
Washington Plastic Surgeon
4.0 out of 5 stars 27 reviews

Implant revision

If your implants have bottomed out and you have thinness or rippling, strattice may be a good solution to help with your problem. The cost can be quite high with the Strattice, but it depends upon the size of the pieces used.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Complications of breast augmentation- implant displacement

it seems that you might have lost some weight. In these situations the implant becomes more visible and you would start to see wripling. Thin skin can also stretch causing the implant to bottom out, even though implants are under the muscle. I suggest that you consult with a reputable plastic surgeon and discuss your options for possible breast lift surgery.

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.4 out of 5 stars 49 reviews

Strattice is an excellent option for bottoming out

Though your implants are not particularly large, the tissue can thin which results in loss of support and visible ripples. Strattice is an excellent option for this though it is not inexpensive. (The cost would depend on the size of the pieces needed.) However, in a situation like yours, there is a high probability that you will be unhappy with the appearance of the breasts with implant removal.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Bottoming Out of Implants

If you have think skin or minimal breast tissue, the weight of the implants can stretch out the support of the breast overtime and cause what you are describing in some people.  However, if you post pictures, we may be able to give you more specific advice.  If you remove the implants only, you may be left with loose skin and require a mastopexy or breast lift.  It may be best to switch to a slight smaller implant and place Strattice at the same time.  You may also need a lift component to the surgery, but this con only be determined by an examination.


Good Luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

Breast implant bottoming out

Bottoming out of breast implants can be improved with subcutaneous corseting of the tissue and/or strattice/alloderm.  The amount of tissue support underneath the breast implant will guide the rate at which recurrence occurs.

Dr. Karamanoukian

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Biologic implants and breast implant revisions

The other surgeons certainly have outlined the questions what should be ask of you when you see a PS.  Knowing what kind of implant you have and its location as well as the presence of a capsular contracture are all vital.  I often use Strattice in performing revisionary surgery.  It is costly and can easily double the cost of an operation, however I have found that the results are long lasting and can correct problems that are not easily corrected via other techniques.

Delio Ortegon, MD
San Antonio Plastic Surgeon
4.1 out of 5 stars 25 reviews

Implants bottoming out

There are several unknowns here.  Do you saline or silicone implants.  Has your weight changed or have you given birth?  Does your left implant feel heavy because it is becoming contracted?  Stratice offers an excellent means of correcting the issues you raise but it is costly, and can easily double the price of the surgery.  I think you should explore alternative means of correction such as replacing a saline implant with a silicone one, performing a capsulorraphy, or even utilizing a neo pectoral pocket if your left implant ic contracted.  Once you have explored these alternatives you will be in a better position to decide how to proceed. 250CC implants are not large implants and I do not feel that you should downsize.  If your body has changed since you had the BA  an uplift may help you.  At best, removing the implants will leave you looking the way you did prior to your surgery,  and that is why you had them inserted, so think long and hard before you remove them.

Beverly Friedlander, MD
Short Hills Plastic Surgeon
4.8 out of 5 stars 15 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.