Bottoming out? Malposition? Inferior pole stretch? I'm 5 months post op. (Photo)

Question

375cc round mod plus under the muscle - and so unhappy with my results. What is going on? I am very uncomfortable when I don't wear a bra so I wear one 24/7. But when I am wearing one the right breast pushes down a lot and will sometimes come out the bottom. They feel so low and heavy!

Tom J. Pousti, MD · Answer

I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”).
It is possible that you are feeling the implants significantly along the lower poles of the breasts. Patients in your situation often complain of discomfort in the area of implant malposition. Also, consistent with the breast implant positioning problem, the nipple areola complexes seem to be sitting relatively high, because the breast implants have settled too low. 
Generally, signs of breast implant bottoming out include: 
1. Breast implant "sits" too low on the chest wall.
2.  Excessive palpability or visibility of the breast implant along the lower breast pole.
3.  Nipple/areola complex seems to be sitting relatively high, because the breast implants have settled too low. 
4. Discomfort along the lower breast pole (secondary to pressure from the underlying implant).
5. Relative paucity of upper pole breast implant volume compared to lower pole volume.
6. Increased visibility of a infra mammary fold scar (higher on the breast mound).
I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). Sometimes, depending mainly on the patient's history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh. This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation.
 I hope this helps.

Daniel Barrett, MD · Answer

Dear raf2017,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

Anthony J. Taglienti, MD · Answer

Thank you for your question. I completely see what you are talking about, and there are a variety of reasons that this may have happened. Without seeing your pre-operative photos, it's possible that you may have needed a lift when the implants were placed. Or, it may just be how you healed and your skin quality. The inferior or lower part of breast skin can be tightened to lift the implants on your chest - I would suggest having an in-person consultation with a Board-Certified Plastic Surgeon to find out all of your options - nothing replaces the information obtained from a physical examination and actually feeling the extent of your implant pocket, etc. Best of luck!

Mahmood Kara, MD - Account Suspended · Answer

Hello. Thank you for your inquiry and congratulations on your surgery!
It is important to have an in-person medical assessment regarding this issue as it is difficult to determine virtually. Continue to update your doctor in the matter and follow their post-op protocol.
It is important to get cleared by your doctor before engaging in specific physical activity before the 3 month healing period has ended as the healing stage is crucial for healthy results.
It generally takes around 6 months to a year to see your final results. Your tissues will take time to relax and allow your implants to "Drop and Fluff" settling into place.
Our tips for recovery following breast augmentation are to wear a supportive sports bra for 3 months post-operative and refrain from lifting anything heavier than 10 lbs for 3 weeks as we don't want any strain at your incision sites. Make sure to keep the area of your stitches clean by cleansing with hydrogen peroxide daily. Showering is encouraged! But, no sitting in water for 2 weeks following surgery (no baths, hot tubs, pools etc.).
Please note that this response does not substitute patient-doctor relationship. We welcome any and all patients seeking advice to come in for a complimentary consultation available for limited time only.
During the COVID-19, we are offering complimentary online consultations as well as in-office consultation with social distancing and masks. Procedure done in-hospital private surgical facility while taking covid-19 precautions. We utilize UV-light to clean the air of viruses and bacteria during our consultations and surgery. We invite you to come in to discuss your options more thoroughly. Please send us an email at info@drkaraplasticsurgery.com with the subject line: "Attention Meagan" and we will be happy to coordinate your appointment!
M.Kara,MD,FRCSC (27+ years experience) - Specializing in 24 hour recovery/ out to dinner breast augmentation in-hospital private surgical facility for your added safety and peace of mind

Lawrence N. Gray, MD (retired) · Answer

Your implants are too low. They were either placed too low at the time of surgery or were not sub muscular, but sub pectoral. I have seen sub pectoral implant even lower than yours at 6 months. The deforming force from the pectoralis major is down and lateral. I always use a sub muscular pocket with the pectorals major and serratus anterior together. You can be corrected with elevating the serratus and suturing it to the lateral border or the pectorals major. Some surgeons would use Alloderm, but it is very expensive. Some surgeons would use an inferior capsulorhaphy.

Bottoming out? Malposition? Inferior pole stretch? I'm 5 months post op. (Photo)

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Answer: Implants Too Low

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Bottoming out? Malposition? Inferior pole stretch? I'm 5 months post op. (Photo)

Answers (5)

Answer: Recommendation

Answer: Recommendation

Answer: Implants Too Low

Answer: Implants Too Low

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Recommended reading

Everything you need to know about Breast Implants

Our mission is to create a world where every investment in modern beauty is Worth It.