How did my revision fail? (Photo)

I would appreciate doctors' opinion here. I had a revision on my right boob to fix "bottomed-out" condition. My doc did internal suture to repair the pocket at the crease. It looked great for 2-3 weeks and now 2 months later, I am back to square one again. Looks like my right boob has settled lower than where the suture was created. Could you please explain what could have gone wrong? Am I doomed for another surgery? (275 CC Saline under, moderate plus)

Doctor Answers 5

Failed procedure?

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Its difficult for me to appreciate what has failed.  You started out with different size and shaped breasts and you still have different shaped breasts, only larger.  When you start critiquing results, there are many issues to look at.  Is the top level?  Are the nipples level?  Are the folds level?  Are the sizes near equal?  Once you figure out what bothers you the most, revisions can help improve the final result.  And if it is truly fold issues where one side is bottoming out, you can choose to use man-made products such as Strattice or accept an external scar and tighten the tissues from the bottom, assuming the fold is near level.

Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

You may have thin capsular tissue

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Thank you for the question. There are many reasons for recurrent bottoming out. In cases where direct suturing fails, often a acellular dermis (Alloderm, Flex HD) or a biologic mesh (Seri) are a little costly but needed to help the repair hold long-term. 

Wesley G. Schooler, MD
Santa Barbara Plastic Surgeon
4.8 out of 5 stars 17 reviews

Internal bra for recurrent bottoming out

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Many factors contribute to bottoming out. many surgeons believe that saline implants are more likely because of a fluid wave effect that puts pressure on the scar capsule with motion. When it is repaired with a capsulorrhaphy as you had, it is not the suture that provides long term support but your own tissues. When the tissues thin out and allow the implant to drop, they are by definition already weakened. The concept of the internal bra is to add a layer of support using materials such as Strattice, SERI scaffold silk, or GalaFLEX mesh. 

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews


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Thank you for the photos but an examination is really needed.  Practically your sutures could have pulled out similar to a failed hernia repair or your tissues just stretched.  Either way there are other options for reconstruction that may be more reliable

Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 65 reviews

Revision Surgery Failure

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I am so sorry that you still have this problem!  There is a small minority of women that have the opposite problem to capsular contracture; they make too little scar capsule to support the implant.  I would say that any revision surgery you have should be different than the one you just had, obviously.  

Only your surgeon would know the details of what he did, like what type of suture, how many sutures, or any other surgical manipulations of the capsule. Based on those details, the surgeon could then decide on what additional measures should be taken. The most obvious would be to use a larger, braided, permanent suture, with multiple rows of stitches to encourage scar formation.  Another change might be to include a product called 'acellular dermal matrix' or ADM like Alloderm or Strattice to reinforce that capsule walls.  This product is very expensive, unfortunately.  Finally, you may want to consider changing to a textured implant, preferably silicone gel or form-stable silicone gel to help with adhesion of the implant into the pocket.

I hope that the third time is the charm, and I'm very sorry that you've had to go through this experience.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 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.