I have bottomed out 3 times- should I explant?

Unfortunately, you have not provided photographs. However, if you have bottomed out 3 times, I do not think the 4th time will be the charm. 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.

Hello, thank you for your question!! Please watched the attached video that provides a detailed response to your question specifically. I am sorry to hear that you've been struggling with these issues. It sounds incredibly frustrating and painful. Options could include capsulorraphy (tightening of the capsule to prevent the implant from moving) or a mesh/sling (internal mesh to support the implants from bottoming out) as I have described in my video. Consulting a surgeon who specialized in complex breast surgeries or reconstructive surgery may provide new insights or alternative approaches. It is valuable to seek opinions from multiple surgeons to explore all potential options and ensure that you are making an informed decision.

Dear Dazzling4087,
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

Hello @Dazzling4087, thank you for your question. You should have an explant with total capsulectomy and since you have good breast tissue I would consider a breast lift to rearrange the breast tissue and lift the areolas and nipples. The shape of the breast is improved by rearranging the breast parenchyma. I understand your concerns regarding breast animation deformity and chronic pain. It is possible that the underlying cause of the symptoms is related to the pectoralis muscle attaching to the chest wall. However, a thorough consultation and examination would be necessary to determine the cause of the problem and treat it. To shed more light, I share a video. If you are considering breast explantation, consultation with a plastic surgeon experienced in this procedure is essential to ensure optimal results. Best regards.

Alan Gonzalez MD, FACS. Member of the International Federation for Adipose Therapeutics and Science (IFATS), Member of the American Society of Plastic Surgery (ASPS), Member of the Colombian Society of Plastic Surgery (SCCP).

Hi there,
Can you provide some more details about your previous surgeries, including your implant sizes, and some current photos. That way we can better answer and provide help
All the best

You did not post photos not stated what size of implants you have, so I cannot be specific., Usually, repeat bottoming out is related to having implants too large and heavy for your frame and tissue. Your tissue is not supporting the weight. I would suggest going smaller.

It's important to consider why you are bottoming out. Sometimes large implants can lead to this occurrence. You may want to consider adding bioabsorbable mesh. This can add support if the bottoming out is occurring from the tissues being thin. I've included a video I hope you find helpful.

To make a quality assessment regarding the outcome of any plastic surgery procedure, we generally need to see a Complete set of proper before and after pictures.
If you’ve had more than one procedure, then we should ideally see before and after pictures for each of your previous procedures.
If you don’t have before, and after pictures, then I suggest contacting your providers and asking them to forward all the pictures they took.
You should also ask Those surgeons to forward operative reports or preferably entire copies of your medical record.
Breast augmentation outcomes are based on three variables.
The first is the patient candidacy for the procedure in the first place.
The second is the choice of implants in regards to size shape and type.
The third variable is the surgeon ability to place the implants in the correct anatomic location.
when things don’t turn out well we can almost always identify the problem as being related to one or more of these three variables.
Using excessively large implants will increase the risk of complications and need for revision surgery.
Implants bottoming out is typically a result of surgeons, not being able to place the implant with sufficient supporting tissue to hold the implant in place against contractile forces of the pectoralis muscle and gravity.
This happens much more frequently when patients choose excessively large implants.
Correcting bottomed out implants is difficult, and should only be attempted by those who have proven track record.
Bottomed out implants can be corrected but getting a quality outcome that lasts requires being in the hands of the right provider and may require using appropriate size implants if the current implants are excessive.
correcting bottomed out implants is often done with internal permanent sutures that can be reinforced using either cadaver dermal products or mesh. There are a lot of variables to take in the consideration.
The more revision surgeries somebody has had the more complicated the situation becomes.
Provider selection is absolutely critical.
This is true for both primary and revision surgery.
Patient should also be careful with implant selection And recognize that bigger implants come with much higher complication rates.
Without having any pictures, we can’t begin to make an assessment.
If you’re interested in having breast implants, then you should not explant now.
Removing the implants and then attempting to augment later is generally not a good strategy.
To get an assessment of your condition, and if equality outcome is possible, you’ll need to rely an in person consultations.
To find the right provider I suggest patience start the process by having multiple in person, consultations with plastic surgeons who have a strong history of breast surgery, including revisions, and often reconstructive surgery.
During each consultation, ask each provider to open up your portfolio and show you their entire collection of before, and after pictures of previous patients, who have similar body/breast characteristics to your own.
For common procedures and experience providers should have no difficulty showing you the before and after pictures of at least 50 previous patients.
This is probably not going to be the case for complex revision work.
Still does who have a proven track record should have evidence of quality outcomes, preferably long-term outcomes.
Finding the right provider may take having quite a few consultations.
I generally always recommend people have multiple consultations before scheduling surgery.
The biggest mistake patients make is having only one consultation and then scheduling surgery.
Doing that basically eliminates the ability to choose the better provider.
For revision work, the need for provider selection that becomes even greater.
I generally do not recommend people travel long distances for elective surgical procedures, if possible.
I also do not recommend people rely on virtual consultations before having surgery.
Most communities will have a handful of really talented plastic surgeons for breast surgery.
Finding those providers may not be easy or straightforward.
The best plastic surgeons are often not involved with self promotion, social media, or putting their name out there where they rank high on Google, searches or other Search criteria. If anything, there’s probably an inverse correlation relationship between surgical, skill and surgical fame.
Most of the best plastic surgeons, I know are usually busy taking care of patients and are not involved in promoting their practice.
This means they may not have a lot of before and after pictures on their website and they may not be generating lots of reviews and other things associated with self promotion.
I’m not sure what part of the country you’re in but if you’re close to Southern California, you may want to consider Tom Pusti MD. He does a lot of complex breast surgery and has an excellent reputation for correcting difficult outcomes.
In that area, you may also want to consider Mark Kobayashi MD.
You may want to look up who does the majority of breast cancer reconstruction in your area and talk to those plastic surgeons as well.
It’s not appropriate for us to tell you what procedure to have especially without having access to important information.
I suggest you consider first collecting all the information you need to present for a proper second opinion consultation.
This should at a minimum include well organized, proper before and after pictures for each of your previous procedures.
It should also include operative reports for each of your previous operations.
Next make a list of potential providers, preferably close enough that you can have in person consultations.
It may be reasonable to reach out and do a virtual consultation before traveling to meet with the surgeon who is far away.
I still think it’s important to have in person consultations to get a quality assessment and more so for the patients to be able to vet the provider.
In the end, it’s the and surgeons are responsible for the surgical outcome, and patients are responsible for provider selection.
Some patients do ultimately fail breast augmentation.
Having bottomed out implants should generally not be an indication to fail augmentation, but sometimes it can.
Best,
Mats Hagstrom, MD