Do I have bottoming out? How can this be corrected? (Photos)

Question

Hello. 6 months ago, I had a breast lift operation without implants. On the left breast, the horizontal scar is located in the middle of the chest, not below, and the left side is lower than the right. How can this be corrected, will it be enough to remove the skin only at the bottom of the chest?

Joel Patrick Maier, MD · Answer

Overall your results are very good. Excellent shape and proportion. I can see what your concerns are from the photos. A revision of the right breast with removal of a wedge of tissue along the horizontal axis of your breast will help tuck that scar in the crease. I hope this helps, thank you.

Emre Guvercin, MD, FEBOPRAS · Answer

Your result is pretty good, the condition is called a light bottoming out, can be corrected with resecting some skin and soft tissue to decrease vertical height between areola and inframamarian fold

Daniel Barrett, MD · Answer

Dear Thriving569856,

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

Jeffrey M. Darrow, MD · Answer

Thank you for your photographs. It appears that your symmetry is very close. If you feel that your scars are unacceptable, a scar revision may be performed to improve their appearance.  It’s important to understand that perfect symmetry does not exist and is not created with an operation and that when you revise a scar you are always trading one scar for a new scar and anticipating that the second scar will be better. Discuss this in detail with your plastic surgeon.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Dear Thriving,
Thanks for your photos and the info! Based on what I see: Yes, it looks like your left breast may have bottomed out—that means the breast tissue and scar have dropped lower than they should. This creates an increased distance from the edge of the areola to the fold.  
here are a few good options:

1.  Skin Removal Alone?
Removing skin from the lower part may help—but it probably won’t be enough on its own.
2.  Internal Support (aka “Internal Bra”)
A better fix may include tightening the tissue inside your breast to help hold it up—like giving it a better “internal bra.”
3.  Scar and Nipple Repositioning
The scar and nipple can likely be moved to better positions for a more balanced look.

You’re 6 months out—a good time to plan a revision if it’s bothering you.
Make sure to see a board-certified plastic surgeon who does revision breast lifts. Bring your original surgery report if you have it.
Let’s get you back to feeling confident in your results!

Warmly,
Earl Stephenson, Jr, MD, DDS, MBA
ESJ Aesthetics – "Where Confidence Takes Shape!"

Eric Swanson, MD · Answer

It's not unusual to get a little bottoming out. This can be revised by removing more skin and tissue from the crease area under your breast, "cinching" the breast, and producing more lift. Usually there are no additional scars, but rather replacement of your existing scars with new ones in a similar position.

Scott C. Lindsay, DO · Answer

Thanks for your question! You may be bottoming out a little bit. This could be corrected with some capsule work or skin excision but that would be determined in person. I would suggest an in-person evaluation for best options. Good luck!

Camille Cash, MD · Answer

From the photos a revision would improve the shape.  The excess skin would be removed and the nipple position corrected.  You may be a good candidate for bioabsorbable mesh to provide more support to the breasts.  I've included a video I hope you find helpful.

Darryl J. Blinski, MD · Answer

Based on, you’re not supposed to photos I would use some type of internal bra on the bottom outside with star tissue revision. Expect fees to arrange from $15-$25,000. Best virtual consult

Connie Hiers, MD, FACS · Answer

A little more skin and, if needed, breast tissue can be removed using the inferior incision. This could be done under local in the office.

Do I have bottoming out? How can this be corrected? (Photos)

Answers (10)

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