Bottomed out Even After Internal Sutures.. Am I Just Not a Candidate for a BA? (photo)

First BA (infra incision) in 2007 w/ submuscular silicone (250cc), bottomed out within 3 months on my right side. Explanted, and tried again (2011) w/ a revision specialist, & submuscular saline (275cc) mod profile & internal bra on both sides. Bottomed out again on same side. Dr. was surprised given the aggressive internal sutures. I’m explanted now, but want to try again. Dr. suggested Strattice, but can’t guarantee it won’t happen again. Am I not a candidate for a BA? Pics attached

Doctor Answers 13

Bottomed out Even After Internal Sutures.. Am I Just Not a Candidate for a BA

Thank you for your question.  Sorry your are experiencing bottoming out for the second time.  There can be a high recurrence rate when elevating the inframammary fold.  For your third surgery I would recommend acellular dermal matrix, Seri or similar product.  Use an underwire bra at all times for 6-12 weeks.   Discuss your option with your board Certified Plastic Surgeon. Best wishes.

Dallas Plastic Surgeon
5.0 out of 5 stars 104 reviews

Bottomed-out even after internal sutures. Am I just not a candidate for a breast augmentation?

Hello!  Thank you for your question!  Given your history of failed attempts at revision to correct symmetry and shape issues, consideration for either an acellular dermal matrix or mesh-type substitute is reasonable.  A capsulorrhaphy would be needed for revision of your breast pocket. If you do need such, the use of a dermal matrix or mesh may be considered if your tissue now has significant laxity that is failing in support or a significant deformity in which recreation of the breast pocket is required along with adding additional support and coverage of the implant.  Certainly, the larger the implant, the heavier the weight...thus, it may be useful to consider placement of a matrix or mesh. Otherwise, capsulorrhaphy for pocket revision using your native tissue should suffice.  It has been used safely and effectively to correct synmastia, restore the inframammary fold, mask implant issues (e.g., rippling, wrinkling, etc.), and improve aesthetic results in revisionary breast implant and reconstructive procedures.  However, only by physical examination would one be able to make recommendations on the benefits over the risk of using a matrix or mesh in your situation. 

Consult with a plastic surgeon well-versed in breast procedures and the use of dermal matrices and mesh in breast procedures who will assist you in determining which procedure(s) would be the best for you.

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Easeally to correct by subfascial way/ muy facil de corregir por via SUBFASCIAL

your problem is quite usual when submuscle way is done, now we  avoid bottiming out by subfascial way.

su problema es muy comun cuando se usa la via  submuscular  es facil de corregir y de evitar por via subfascial

Ramon Navarro, MD
Mexico Plastic Surgeon
5.0 out of 5 stars 2 reviews

Bottomed out Even After Internal Sutures.. Am I Just Not a Candidate for a BA?

      A dermal matrix would be the next logical step to prevent recurring bottoming out.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Bottomed out Even After Internal Sutures.. Am I Just Not a Candidate for a BA?

I have found that synthetic mesh works well inn recurrent cases such as yours.It appears that mesh  adheres  more rapidly than acellular matrices such as strattice

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Bottoming out

If you have bottomed out for a second time, you may want to go with smaller implants, and possibly strattice. I also like to have patients wear a thong bra.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Breast augmentation following recurrent implant malposition ("bottoming out")

Implant malposition ("bottoming out", lateral displacement, etc.) can be very difficult to correct surgically.  The ability of internal sutures to hold up over time is dependent upon the strength of the tissues being sutured.  While the success of using an acellular dermal matrix (eg. Strattice) cannot be guaranteed, it has been very useful for correcting difficult / recurrent cases of implant malposition.

Because silicone gel is more cohesive ("thicker") than saline, a gel implant may exert less force on the lower pole of the breast compared to the same size / shape saline implant, and may have a lower risk of bottoming out.

I would recommend consulting with several board-certified plastic surgeons experienced at performing breast augmentation revisions, who can review your history, perform a physical exam and recommend treatment options appropriate for you.

Good luck.


Craig S. Rock, MD
Houston Plastic Surgeon
5.0 out of 5 stars 29 reviews

Bottoming Out Again

At this point in time you need an alternate approach. I use Strattice for just such an issue. Sutures will not work because they will just tear through as your tissues are most likely thinned out. Strattice will help control the pocket and act as an internal hammock to minimize the downward forces of the implant on your own tissues. From the photograph it appears that you already have an incision in your breast fold which is the incision that I prefer to use so you would not need any additional incisions.

Hope that helps,

Dr. Babak Dadvand

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 44 reviews

3rd Breast Revision

Thank you for your photos.  The use of STRATTICE® is a good idea but there are no guarantees.  If the use of STRATTICE gets you closer but not perfect then I would recommend you stop there.

Dr. ES

Recurrent bottoming out problem

Time for plan B.  If plan A fails twice plan B is do not do plan A again.  You will get the same result.  Using a material like Strattice makes sense since you have thin skin and are having problems supporting the weight of the implant. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

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.