Should I be concerned about bottoming out after a revision surgery to add mesh? (photo)

Question

My initial breast augmentation & lift were in June 2020 (silicone, crease incision, moderate profile 405/360 cc). By late August it was clear both were bottoming out. I scheduled a revision to add mesh below the implants & had that surgery in November 2020. Since the revision, the left side seems to have bottomed out even more than before the revision. What would cause this? Is the mesh in the wrong place? Do I need to fix this? My surgeon said he considers this a "good outcome."

Donald R. Revis Jr, MD · Answer

Good afternoon,
I repair hundreds of bottoming out cases a year, and unfortunately your photos are so close up and cropped I can't tell a thing from them- either post better pics or email me directly. Usually the repair fails because because of a technical failure because the surgeon is inexperienced. NEVER choose a revision surgeon who cannot show you hundreds of their own revision procedures before and after pics- revisions are the most difficult surgery in all of plastic surgery- just because someone can put implants in a first timer does NOT mean they can perform revisions. And each failed revision becomes an even more difficult job for the next surgeon (and typically more expensive for the patient as well).

Zoran Potparic, MD · Answer

It is very difficult t make good diagnosis based on these photos, but it appears that you have more of double bubble deformity than bottoming out? In person consultation, secondary opinion, with another board certified plastic surgeon, expert in breast surgery, is recommended. Good luck.

Gerald Minniti, MD, FACS · Answer

I'm sorry about your persistent troubles. Mesh has virtually eliminated recurrent drop out in my practice and many of my colleagues. It sounds like you need to see another surgeon.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs. Unfortunately the scale of the pictures prevents accurate evaluation of your results.  Please repost the images.

Daniel Barrett, MD · Answer

Dear kconfetti,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mark Lee, MBBS, FRACS · Answer

Thanks for the photos This looks to me like a double bubble from the previous Inframammary fold being visible and as you say the implant bulging below

Joshua B. Hyman, MD · Answer

Thanks for the pictures. It looks like you have a double bubble issue or maybe a dynamic issue and not just bottoming out. I would get a couple more opinions if your breast surgeon not being helpful. It is quite difficult to correct these issues as they are caused more from your breast anatomy and not the implant itself. I wish I could suggest an easy fix.

Camille Cash, MD · Answer

Unfortunately it is difficult to give you a proper recommendation from the given photos.  I encourage you to visit with a few board certified plastic surgeons near you for consultations.  Discuss your concerns and listen to varying opinions and options.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question but an examination is really needed.  So if you have concerns get your records and preop photos and go on some complimentary consultations with experts and compare recommendations after a full examination and discussion of desired results 
 
Dr Corbin

Should I be concerned about bottoming out after a revision surgery to add mesh? (photo)

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