Fixing bottoming out and bigger implant while keeping with the subglandular position? (photo)

Can I go from 250cc high profile to 375 moderate silicone and manage to fix my bottoming?

Doctor Answers 8

Fixing bottoming out and bigger implant while keeping with the subglandular position?

Thank you for your question. Going from 250cc to 375cc will not make the lower pole of your breast any better. Based on the photos submitted, the inframammary fold will need to be raised and reinforced internally to correct the bottomed out look. I recommend that you make an appointment with a board certified plastic surgeon to discuss your surgical options.

Fixing bottoming out and bigger implant while keeping with the subglandular position?

Thanks for your question and photos.  A capsulorrhaphy to close the lower pocket is highly effective in my experience however I would discourage you from "challenging" your repair by placing a larger and heavier implant.  There is a reason that you suffered the drop-down that has occurred and a heavier implant may cause the same problem to recur.  Discuss this with your surgeon and good luck.  Regards,

Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca 

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Implant revision needed

Based on the photographs submitted and some educated guessing, I believe the original procedure was performed through a trans-axillary (armpit) incision and under the muscle.  One of the dangers of going through the armpit is over dissection of the pocket inferiorly and medially, which has happened in this situation.

The implant pocket needs some modification, especially raising the crease.  This will need to be performed through an inframammary incision (new scar) and an implant exchange can be performed at the same time. A 375 cc implant would not be a problem.

Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 73 reviews

When bottoming out repair needs reinforcement

It looks like the tissues are very thin around your implants, which is a reason for bottoming out. Especially if you are considering going larger, you should consider reinforcement of the capsule with an internal bra procedure. This involves placement of a layer of material to add coverage and support, like Strattice or Galaflex.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 47 reviews

Fixing bottoming out and bigger implant

With the size implant you are wanting, it should be a fairly straightforward procedure to do a capsulorrhaphy (tightening of the capsule) at the bottom of the breast and loosening the capsule at the top to restore the look you want. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Bottoming out of breast imlplants

Thank you for your question and helpful photos. 

Attempting to replace your current implants with larger ones is not sensible. The bottoming out must be corrected by reinforcing the inframammary fold by either using scar tissue, capsule, or other material. Adding more weight by increasing size of implant may jeopardize your revision. Best wishes,  

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.7 out of 5 stars 209 reviews

Fixing bottoming out and bigger implant while keeping with the subglandular position?

I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”).



It is possible that you are feeling the implants significantly along the lower poles of the breasts. Patients in your situation often complain of discomfort in the area of implant malposition. Also, consistent with the breast implant positioning problem, the nipple areola complexes seem to be sitting relatively high, because the breast implants have settled too low. 



I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). Sometimes, depending mainly on the patient's history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh. This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation. 



 I think, based on the photographs, that it is likely that larger breast implants can be utilized safely,  despite having the capsulorraphy procedure performed.  In my practice exactly what breast implant size/profile will best achieved the patient's goals (again safely) is best determined using intraoperative sizers during surgery after careful communication with the patient prior to surgery.



Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery. 

I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.  Best wishes.

Can I have larger implants when smaller ones bottomed out?

Thank you for asking about your breast implant revision.

You really need an examination to determine if large implants will fit your chest. It is also important to figure out why they are bottoming out - is it your tissues or was the crease disrupted at surgery or was there no crease to begin with. Correcting the bottoming out will make the implant space smaller - one reason a larger implant may not fit. An internal support material will be needed if your tissues are weak. Discuss all this with your surgeon before having anything more done. 

Best wishes. Elizabeth Morgan MD PHD FACS

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.