Is This Malposition, Bottoming Out? (photo)

Hi I have one breast lower then the other .I am not happy with the result .What cause this asymmetric and what can I do to correct this . Is my surgeon responsible for this ?

Doctor Answers 6

Are your breasts bottoming out?

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Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.
Bottoming out and Side Boobs Contributing Factors:
  1. Larger/Heavier Implants
  2. Implants placed above the pectoralis muscle
  3. Chronically not wearing a bra when upright
  4. Over dissection of the Implant Pocket
  5. Smooth Implants
  6. Large swings of weight including pregnancy
  7. Skin and soft tissue laxity, loss of elasticity

Is This Malposition, Bottoming Out?

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Thanks for the posted photo. The issue is what did you look like before the implants? Where you asymmetric than? If YES, than implants magnify the asymmetry by the sear increase in volume. Or was the operation/dissection done poorly by the surgeon? My recommendation is to discuss with your surgeon these issues IN detail. Than if a mutual solution can be attain proceed. Otherwise seek second in person opinions. 

Malposition of Bottoming out

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This is hard to tell without the preoperative photographs. Your nipples and areolas look like they are at the same level. Repair of the fold or different implants are both options.

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon

Bottoming out?

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It certainly looks like you have bottoming out.  An exam in person would be best to assess the situation.  Solutions to correct bottoming out can include placing smaller implants and fixing the fold.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast Implant Malposition/Bottoming Out after Breast Augmentation?

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I'm sorry to hear/see the complication you have experienced after breast augmentation surgery. As you know, the breast asymmetry is related to an asymmetric positioning of the breast implants. Unfortunately, it is not possible to ascertain whether this breast implant asymmetry is secondary to an error in breast implant pocket dissection or postoperative breast implant movement ( which can occur occasionally, despite best efforts).

   At some point, you will benefit from revisionary breast surgery; make sure your plastic surgeon  (or any plastic surgeon who you choose to perform the procedure)  can demonstrate significant experience helping patients in your situation.

Best wishes.

Malposition or Bottoming Out

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Without the opportunity to see pre-op photos it is hard to answer any question about malposition. From the posted photo it looks to me like bottoming out, but again some more info would be helpful. For example, if this were a one week post op I would not consider bottoming out nigh on the list. 

The right implant is lower than the left and it looks like it is lower that the breast fold, which defines bottoming out.  This is a known risk. Surgery to restore the breast fold is the fix for this.  

Many surgeons will not charge a professional fee in this setting, and the only fee would be for the operatory and anesthetist. 

Thanks you for your question and for the attached photo.

Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.