Is my right implant bottoming out at only 6 weeks post-op? (photos)

Question

I had 290cc round silicone under muscle implants 6 weeks ago. From the start my right implant has looked alot different from the left (normal I know) but it seems to be slipping lower everyday. I can feel the implant underneath as if the pocket it is in has opened up at the bottom, or was not closed properly in the first place. Is this due to over disection of the pocket and can this be fixed before it gets any lower, with some stitches to close the pocket and push implant back up.

Aldo Guerra, MD · Answer

Thanks for your question. In the photos, it is quite hard to see what is going on with your right breast. There may indeed be a small amount of bottoming out as the implant migrates below the original fold. This can be treated with revision surgery, but you wold have to see your plastic surgeon about your options. Suturing with fold reconstruction is only one option. Best wishes, Dr. ALDO

Giorgio Netri, MBBS · Answer

Thank you for your questions and pictures.

As you said the two breast at the beginning can look different as they settle in different time and six weeks is still an early stage.

Bottoming out means that the implant is sliding outside the desired pocket: to confirm this will need a consultation and an examination.

It is possible if this is that case to re -stitch the pocket internally but I advice to speak with your surgeon about timing.

If need I prefer to wait few months when the other implant is fully settled to avoid more surgery and when the scar is not so fresh to avoid complication.

Regards

Mr Netri

Jacob Freiman, MD, FACS · Answer

They do not appear to be bottoming out. Rather, one appears slightly smaller. This may be due to the fact that it is slightly higher and needs to settle.

Anne Taylor, MD · Answer

Hello. thanks for including pictures. Actually it does not look too bad. It is normal to feel the implant along the lower pole since you are very lean with a very small amount of breast tissue. I would recommend a supportive bra with an underwire to counteract our enemy-- GRAVITY.  The skin is elastic and will stretch over time due to the weight of the implant so you need to keep it up with a good bra.Good luck.

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast augmentation surgery. Your concerns are understandable; the photographs do demonstrate breasts that one of the breasts has more volume along the lower breast poles than upper breast poles. Whether or not you have "bottoming out" may be a matter of opinion but if you feel that there is too much volume inferiorly and too little upper pole volume, revisionary breast surgery may be helpful. Adjustment of the breast implant capsules (capsulorraphy) would likely be necessary to achieve an outcome that you are happier with. With this procedure, the breast implants will sit higher on your chest wall and concerns regarding position of nipple/areola complexes on each breast mound will also be alleviated. You may find the attached link/video helpful to you as you learn more.

Best wishes.

Best wishes.

Marc J. Salzman, MD, FACS (retired) · Answer

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 follow-up with your chosen plastic surgeon and come up with a plan to improve the situation. Good luck.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.  I do see that the right implant is lower than the left which may be partially related to the fact that the inframammary crease, the fold beneath your breast was lower preop.  Eventually a revision of the pocket to lift the fold may be necessary.  However wearing an underwire bra early in recovery  can some times  help this problem and avoid surgery.  Please discuss with your surgeon.

Tarick K. Smiley, MD - Account Suspended · Answer

It appears that your right implant is settling too low, leading to the asymmetric look.  However, revision surgery in which the pocket is tightened can address this problem.

Oftentimes, revision is best postponed for at least six months.  The caveat with performing it sooner is the unpredictability of the results--it's like hitting a moving target.

Good luck and best wishes.

Is my right implant bottoming out at only 6 weeks post-op? (photos)

Answers (8)

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