What is the best option to correct implants that are bottoming out? (photo)

Question

Hi! Last September I had my 12 year implants replaced (saline 390/420). I loved the way they looked but was lacking some fullness and had ripples after kids. They were replaced with 520 gummy bears and shortly after one bottomed out and I had tacking done to correct. I’m not sure if it didn’t work, but I am left with two completely different looking breasts that are too large/wide for my body. What is my best option to correct? I am thinking I will need a small lift and would prefer 400cc

Daniel Barrett, MD · Answer

Dear Fearless738593,
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

Dana Goldberg, MD · Answer

I’m sorry you’re dealing with these issues after your revision surgery. Revisions can be frustrating, because sometimes the muscle and skin are stretched out differently on each side, and this can lead to a different appearance after surgery.

I think you are right on track with your plan for repair. Downsizing the implant and performing a lift will help your implants fit on your chest better, and it will not stress and stretch the lower skin quite as much. You could also consider a sling to help minimize stretching and to prevent the muscle from riding too high, which eventually pushes down on the implant.

Best wishes for the result of your dreams.

Gary M. Horndeski, MD · Answer

At this time, I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

I don’t think you need a lift. You might go with smaller implants and close off the lower portion of the implant pocket from inside  called a cadpdulirrsohy

Connie Hiers, MD, FACS · Answer

Your implants are bottoming out because they are too large and heavy for your tissue. I would suggest going smaller than 400 cc's and doing another lift. You might now need mesh as well.

Kenneth R. Francis, MD, FACS · Answer

Dear Fearless,
I'm not sure why you now prefer 400cc breast implants and you had 520cc implants placed.  Breast implants have weight.  The larger the implant the greater the weight.  Weight is subject to gravity and will stress and stretch tissues.  Downsizing your breast implants is a good idea.  You may need to add a mesh to support your future implants if the tissues are attenuated too much.  Good luck!

Darryl J. Blinski, MD · Answer

Based on your posted, photo a downsizing to 400 cc high profile implants or moderate profile plus with Perry prosthetic capsule fee of lateral pocket inferior get especially on the left breast. To be in the eight to $10,000 range. Best of virtual consult with.

Jason Pozner, MD · Answer

i use galaflex mesh in all of these cases as an internal bra to support the implant. Many times tacking wont hold the implant up.

Mats Hagstrom, MD (license on probation) · Answer

Assessing why breast augmentations look the way they do can be a little bit tricky.
When the breast begins drop down, it’s important to recognize if the weakness is in the IMF or if it’s the breast tissue and skin that’s being stretched out.
Implants are placed under the muscle with sufficient amount of muscle, supporting the implant that the muscle itself is holding the implant on the chest wall.
If the implants are placed above the muscle or if a significant part of the muscle is transfected (sometimes called dual plane augmentation )then the weight of the implant is being carried by the soft tissue under the implant.
it’s hard to tell from the pictures, but it doesn’t look like your IMF is dropping down.
It looks like your breast tissue is stretching out.
That tells me that the weight of the implant is stretching your breast tissue and the implant is not held in place by the pectoralis muscle.
this is a little different than an implant bottoming out.
When the implant bottoms out the structure of the IMF has been lost.
I think the first thing to understand is if your implants were placed above or below the muscle.
ThatI think the first thing to understand is if you’re implants were placed above or below the muscle.
That would make a big difference in what the next step would be.
A breast lift is typically on the indicated when the nipple position is low.
In your case, the nipple position is not low and there’s no indication to do a breast lift because of nipple position.
It’s more that this soft tissue is dropping, but it appears to be in front of the IMF.
I think it’s hard to tell from the information provided.
I suggest you lie on in person second opinion consultations.
For second opinion consultations come prepared bringing with you a complete set of proper before and after pictures for each of your previous procedures and copies of all of your previous operative reports.
If you’ve been working with the same surgeon, then simply ask for the entire medical record, including all of your before and after pictures.
If you initial surgery was done by a different provider then try to get the medical records from that surgery if possible.
I think it’s important to understand what tissue is supporting the implant right now.A good assessment needs to include an understanding of all the previous procedures.
A simplistic approach without an appreciation of why you’re having the problem is likely to lead to continued problems with continued revisions.
Insufficient information increases the chance of making an error in understanding the true ideology of the problem. 
Sometimes having had implants for many years, takes its toll on the tissues, and a lot of this depends on how well the initial foundation was created to support the implant. Again, this generally has to do with if the pectoralis muscle is supporting the weight of the implant or if the implant is being pushed against the lower tissues.
Describing the problem in writing is about as difficult as trying to describe a potential solution.
In the end, the most important variable is provider selection.
Best,
Mats Hagstrom MD

What is the best option to correct implants that are bottoming out? (photo)

Answers (9)

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