Concerned need revision, left breast is pointing upward and can see incision. (photo)

had a breast augmentation almost 6 months ago. 450 cc silicone. I am concerned that I may need a revision. My left breast has not dropped all the way and had always seemed like it moves around a lot. I can still see incision line, unlike the other side which is hidden in fold. What do you think?

Doctor Answers 5

Concerned need revision, left breast is pointing upward and can see incision.

Your implants are "bottoming out" and it looks like your nipple positions were not symmetric before surgery. See your surgeon for discussion about improving this.


Chicago Plastic Surgeon
4.9 out of 5 stars 65 reviews

Bottoming out

The left breast had bottomed out and it is possible that the right breast is headed in the same direction.  The problem is lack of adequate support for your implants.  The lower part of your breast needs to be reinforced.  In my practice this usually means using an off the shelf product such as Strattice.  Suture reinforcement alone has a higher failure rate.  Depending on your wishes you may consider smaller implants.  Whatever you do be very diligent about not 'forcing the issue' and returning to normal activities too soon.

Concerned need revision, left breast is pointing upward and can see incision.

Thank you for your question.

After viewing your photos, it appears that your left implant has "bottomed out" meaning it has descended below the fold of your breast.  When this happens it makes your nipple appear too high on the breast and the incision migrates upward, away from the fold.

In my opinion you will need a revision to correct this.  The pocket on the lower half of your left breast will need to be tightened so that the implant will now rest at the level of the fold as it is on the right side.

You are out far enough from surgery that the revision can take place at any time you are ready.   

Revision after breast augmentation

From the photograph it appears that you have a combination of nipple asymmetry and bottoming out or pseudoptosis.  For the first issue, it is possible that one nipple was always higher than the other and this simply did not change with surgery.  However, this may also be more pronounced with a dropping of the implant. The second issue is related to positioning of the implant. The left implant appears to have dropped below the normal fold under the breast. When this happens, the incision line can ride up onto the lower part of the breast and result in a different shape and appearance. Revision surgery may be recommended for the left breast to better position the implant with re-creation of the breast fold.  This is typically performed with internal stiches but occasionally additional material may be needed in those patients with extremely thin internal capsule formation. I would recommend following up with your plastic surgeon for reevaluation since this issue can develop over the course of several months to years. Thanks for your question and good luck.

Paul B. Mills, MD
Saint Louis Plastic Surgeon
5.0 out of 5 stars 13 reviews

Bottomed out implant

 From your photograph, in my opinion, the left breast has bottomed out.When a breast implant migrates below the original placement location with the bottom of the implant just above the infra-mammary crease, we call this “bottoming out.” There are several causes of this downward migration of the breast implant. Usually, some attempt had been made to lower the crease to accommodate a breast implant whose base diameter is larger than would otherwise fit in the natural breast. In doing so, the anatomic attachment of the skin of the breast to the chest wall can be obliterated. There is then nothing to hold the implant up. With the weight of the implant, and constant gravity, maybe lack of support by lack of wearing a bra continuously, the implant can settle downward. One of the earliest symptoms, I see in patients seeking revision,has been the feeling that the breast has to be constantly adjusted or just feels heavy. We look for the incision line, which was previously placed at the crease, to have migrated upward onto the breast. When we see this early on in the postoperative phase, it will never get better with time and will require a secondary repair. While some plastic surgeons may rely on suturing techniques only, I have found that unless we un-weight the implant by making it smaller or strengthen the tissues below by making them less stretchy, that the same implant, with just sutures placed on the bottom of the pocket, will, over time, recur it's bottomed out position. I have used part of the capsule as well as the lining of the deep muscles and tissues over the ribs in the capsule beneath the breast implants to rotate upward to hold the breast implant in a higher position and therefore obliterating the extra space that has been created between the correct infra-mammary crease and the one created by the downward displacement of the implant. I call this a three flap technique, as the skin, the capsule and fascia (lining of muscles), as well as a dermal flap all contribute to creating a hammock like support of the lower portion of the pocket. When these tissues are insufficient to hold the implant up, or a previous attempt has been made with sutures, I will oftentimes rely on the addition of another type of tissue called an acellular dermal matrix of which my preference is Strattice. This Strattice ,or pigskin, does not stretch and can be sewn in to the bottom of the new location of the crease to support it just like a hammock would. Although this is costly, I consider this an insurance policy against having to redo this again. I would recommend that you try and find a plastic surgeon with experience in revisionary cosmetic breast surgery. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 45 reviews

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