Is this lateral displacement and bottoming out? (Photo)

Question

My plastic surgeon says nothing is wrong and blames it on my breast tissue. I had my procedure done February 2023. They have looked weird ever since I came home the first day. I just feel like my plastic surgeon is not taking accountability. He has done many other procedures and they don't look like this, but mine does so I'm trying to figure out why mine looks awful. At this point, I think I just need to see a different plastic surgeon to fix them.

Nathan Molina, MD · Answer

Hi, I'm sorry you're unhappy with your result. Most plastic surgeons try their best with every patient, and even the best plastic surgeons have some dissatisfied patients. In your case, it's hard to tell from your photos whether the implants have bottomed out/shifted laterally or if the placement wasn't ideal from the get-go. An in-person exam with a Plastic Surgeon would be the first step. Your surgeon may truly believe he did a satisfactory job, but that doesn't mean you're wrong or that you can't seek some improvement. I tell my own patients, pre-op or post-op, that getting a second opinion is never a bad idea!

Wayne I. Yamahata, MD · Answer

There are limits as to what can be achieved though breast augmentation alone and not everyone will have an aesthetically "perfect" breast after the procedure. They are times when additional procedures are necessary, such as a breast lift. Unfortunately, it is not possible to make a valid assessment based on the photos you have provided. If you are concerned, you may want to seek second opinion with another board-certified plastic surgeon.

Sean T. Lille, MD · Answer

Dear Staceface, 
If your scar was in the fold beneath your breast and is now higher up on the breast, you might be "bottoming out" but I don't think it's that because your implants don't look like they have dropped into the bottom of your breast pocket. Your implants may not have "dropped in" properly or you could have a contracture. Either way, You're right, they don't look like they should. I recommend seeking another "in person" opinion from a Board Certified plastic surgeon. 
Best Regards.

Daniel Barrett, MD · Answer

Dear staceface xl,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Zoran Potparic, MD · Answer

It is very difficult to evaluate your result based on these photos. It appears that more lift and higher position of areolas would be better. In person second opinion consultation would help.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  There does appear to be implant malposition and a poor relationship between your natural breast tissue and implant. I would advocate seeking out second opinions as a surgery will be required to correct your results.

Madhukar G. Chhatre, MD · Answer

Hi,
I am sorry your are feeling unheard by your doctor. You have naturally very wide cleavage, and lateral sitting breasts. While this is a VERY normal shape of any breast, it makes it hard for any doctor to carefully place implants in the best spot possible to encourage them not to sit lateral. Over time, gravity and not wearing a bra will cause implants to bottom out, so it is not necessarily the surgeon's fault. However, they should give you options to help correct it. For example, bilateral capsulorraphy, and placement of mesh would be a very good option for your anatomy. You should be wearing a supportive bra day and night. This happens to a lot of women with thinner skin/minimal breast tissue, gravity is always fighting us! You're not alone. Best of luck to you.

Syed M. Sayeed, MD · Answer

Hi from the looks of your pictures you had a submuscular augmentation. I am not sure but the right breast implant looks bottomed out and the left breast looks like its hanging over the implant. 
 Its hard to make out with the large flowers overlying the areolas but from the limited views it appears you may need a breast lift or a dual plane release on the left.
If the right implant is bottomed out you may need to have mesh reinforcement on the bottom and re-creation of the inframammary fold

Camille Cash, MD · Answer

It's difficult to tell from the provided photos if there is lateral displacement and/or bottoming out.  If lateral displacement is present the pocket can be tightened on the outer aspect to prevent the implant from moving outward.  If the implants are bottoming out mesh can be used to support the tissues.  Smaller implants can also be considered.  Visiting with another board certified plastic surgeon for a second opinion may be helpful.

Connie Hiers, MD, FACS · Answer

Even though your photos are not uploaded upright, your implants appear to be pushing out to the sides. Your lateral pockets can be tightened. You might need mesh for support, especially if your implants are large.  If you have little breast tissue, you might need to go down in size for less stress on your tissue.

Is this lateral displacement and bottoming out? (Photo)

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