I'm 25 and had 350cc silicone, under the muscle implants placed 4 months ago. I believed they have bottomed out as the implants now sit significantly lower than the crease incision. I'm getting explanted soon anyway, via local anesthesia, but I'm concerned the bottoming out has lowered the crease to the point that it can't be fixed and now my post-explant breasts will look saggier than they really are because they sit lower? Is there a surgical fix to this that won't lead to asymmetry?
Bottoming Out - Getting Explanted, Can I Fix the Crease? (photo)
Doctor Answers 5
Fix Crease during Procedure to Remove Breast Implants?
For patients in your situation, what I have found helpful is the use of internal sutures ( capsulorrhaphy) done to help reconstruct the inframammary fold area. This procedure is done at the same time as removal of breast implants and serves to improve the appearance of the lower breast fold and hide the inframammary scar better as well.
- Textured implants (“Velcro effect”)
- Use of Smaller Implants
- Maximum Submuscular Position (not just the pectoralis major but abdominis rectus below and serratus anterior on the side)
- Capsulorrhaphy (tightening the pocket by sewing in-folded capsular tissue together)
- Use of Biologic fabrics and other materials such as Acellular Dermal Matrix, “ADM” Alloderm, Strattice, “Silk” and others that can be used to reinforce the bottom of the pocket.
- Change of position of implant to a new pocket location “neo pectoral pocket”
- Internal Ryan Procedure (sutures binding the inferior mammary fold to stronger underlying tissues (e.g. fascial, periosteal)
- Removal of Implants and replacement of volume using your own fat (Fat Transfer).
Bottoming Out - Getting Explanted, Can I Fix the Crease
At the time of implant removal, your surgeon can use sutures to recreate the breast fold at the proper position. All the best.
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Bottoming Out After #BreastAugmentation
From your photos, it does appear that you have some bottoming out. If you are explanting, then not much needs to be done, however, if you are concerned a tightening of the capsule internally can be helpful to restore your anatomy. Keep in mind that there may be some excess skin after the implant removal.
Best of luck
Vincent Marin, MD
Breast Augmentation Revision for Bottoming Out
Thank you for your question. Optimally, the center of the breast plant is positioned behind the nipple. You breast implants seem to have bottomed out, with lower imframammary folds and breast implants centered below the nipples. If you like the size, but not the position, it may be possible to reconstruct the inframammary fold and raise the implants. If you no longer wish to have breast implants. Removing the implants makes reconstruction the inframammary fold much easier and reliable. After the pocket has healed, it would be possible to replace the implants higher, if desired. The link below is to the breast revision page on my San Francisco Breast dot com web site. The first picture in the before and after photos shows an internal repair. For removal, the sooner the better to diminish skin stretch and compression of the breast tissue. About 1% of breast augmentation patients later decide to have their implants removed. Good luck.
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