Is my implant position too low for my body? Am I bottoming out? (photo)

Question

I had my breast augmentation done September of 2023, so a little over a year and a half ago. From day one I have been iffy on if I love my results. I am really happy with how my breasts look in a push up bra, but I feel like I have very little, to no upper pole fullness, and feel like my breasts sit too low and far apart. When I contacted the surgery center that did my procedure they made it sound as if they have zero concerns with the results I was given, however I feel like they say that to avoid having to offer a revision. Please let me know.

Leland Deane, MD, FACS · Answer

Thank you for your question. Without preop photos, implant size, it's difficult to tell much, but I see that the scar (presumably at the fold) is fairly fixed and so, yes, the breast seems 'bottomed out' , meaning that there has been over expansion of the skin between the areola and fold of the breast. This will lead to less fullness 'on top'. The answer is not to put in a larger implant necessarily, which may lead to more expansion of the skin. A second opinion may help if your original surgeon seems reluctant to address your concerns. Hope this helps.

Ellen Ozolins, MD · Answer

Thank you for your question. It sounds like you might be experiencing mild bottoming out or a low implant position. This can occur if your implants sit lower than your natural breast crease or if the position of your nipples appears higher than ideal on the breast mound. When implants settle lower than expected, it can create a deflated look in the upper breast. If your surgical center dismisses your concerns, it’s reasonable to consult another board-certified surgeon to determine if a revision is necessary. Potential options for addressing these issues may include pocket tightening to reposition the implants higher, using mesh support to reinforce implant positioning, or removing the implant and performing a breast lift, followed by waiting six months to have another implant that is smaller than the current one. Choosing the right option will depend on your in-person consultation and examination.

Wayne I. Yamahata, MD · Answer

Your photos suggest that overall, you've had a good outcome. Your nipples may be high on the breast mound, but this may be related to your arms being raised in the photo. If you have concerns, I suggest you begin by discussing these with your surgeon. He or she would have the benefit of knowing your appearance prior to surgery and can exam you to provide an accurate diagnosis.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

I appreciate you offering your pictures. I believe most clients want upper pole fullness, but this sometimes cannot be achieved as a long-term result, unless an overly sized implant is placed. For maximum results it is ideal for the nipple to be in the center of your implant. At times, the nipple position may be a little low and require a breast lift . If you're natural nipple position is normal then the implant should be placed so that the nipple is centered.

If you desire long-term upper pole fullness , I would revisit with your primary surgeon and seek second opinions from other board-certified Plastic Surgeon.

Best wishes,

Earl Stephenson, Jr., MD, DDS, MBA
ESJ Aesthetics

If you desire long-term upper pole fullness , I would revisit with your primary surgeon and seek second opinions from other board-certified Plastic Surgeon.

Best wishes,

Earl Stephenson, Jr., MD, DDS, MBA 
ESJ Aesthetics

Matthew S. Kilgo, MD · Answer

Hello and thank you for your question.
It is very difficult to assess your implant position without preoperative photographs. It isnt possible to alter the position of the breast "footplate" with breast implants,  meaning that if your breasts natural position is low on your chest then the implants will also be in a lower position. In this instance , more upper pole fullness can be achieved with a different profile implant, fat grafting or a combination of the two. I hope this helps.

Sean T. Lille, MD · Answer

Thank you for your question! It appears from your before photo that your natural canvas and tissue architecture suggest you have more tissue along the bottom part of your breasts. In addition some of your lower breast pole skin may have expanded more readily than the other parts of the breast. Without doing an exam assessing whether there is any implant migration or loss of infra mammary fold tissue integrity, it is difficult for me to provide a definitive answer.

Gary M. Horndeski, MD · Answer

Yes, your implants are too low and are bottoming out. The process will continue until you have something done. Your breasts are wider than your chest wall and you have poor cleavage. You have alternatives to consider. One is redoing the breast surgery by repairing the pocket inferiorly and laterally and dissecting more medially. This may or may not be effective. Another is to use GalaFlex to hold the implants in place. Another alternative is to remove the implants completely, lift the breasts and wait 6 months to place smaller implants.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here!My answer will be based on the limited information and pictures provided, for a detailed and personalized plan please consult with your plastic surgeon in person.From the pictures provided you seem to have gotten a reasonable breast augmentation result , you have to keep in mind that the implants are usually high after they are placed and they drop afterwards to a more natural position usually by the year mark they settle . I am sorry you are not completely satisfied with your final outcome, some patients like the higher position of the implants and are dissapointed when they lose some of the upper pole fullness. That being said there are ways to improve the upper pole fullness if it's bothering you from using different implants , through using mesh as internal bra to fat grafting. I would encourage you to discuss your options with your plastic surgeon so they can come up with a plan that works for you.I hope this helps, best of luck!

George Marosan, MD · Answer

Thank you for your question and photos. Based on these photos, you do have slight bottoming out. You also have excess fat tissue in the axilla which should've been liposuctioned at the time of your augmentation. This gives more of an indented look to your breasts laterally. I would recommend a lift of the lower breast pole without elevating the nipple/areolar complex. I would NOT go to a larger implant; your body is already showing that it cannot support the one you have now. The lift can be done through an inframammary fold incision only and placement of a dissolvable mesh for support. The mesh will reabsorb in a year or less, but will strengthen your tissue support of the implant, preventing bottoming out of the lower pole. See a board-certified plastic surgeon for an in-person consultation/evaluation. Good luck.

Frank Agullo, MD · Answer

It looks like you have an accepted breast augmentation result but with some degree of bottoming out and lateral implant displacement. If your goal is to achieve more upper pole fullness and a more pronounced cleavage, a larger and wider implant would be recommended. Additionally, internal mesh support can help hold the implants up and in, acting almost like an internal push-up bra for a longer-lasting, more lifted appearance. If you’re considering a revision, I’d recommend consulting with a board-certified plastic surgeon to discuss your options and create a surgical plan tailored to your goals.

#Staybeautiful @RealDrWorldWide

#Staybeautiful @RealDrWorldWide

Is my implant position too low for my body? Am I bottoming out? (photo)

Answers (18)

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