I had breast augmentation surgery in March, 2010. I underwent a revision surgery on my left breast about 6 months later because the implant was too high. Just a few weeks after the initial revision, I noticed the left implant bottoming out. I presume this is due to over dissection of the pocket. Now, it has been three months and i am in need of a second revision due to the severe bottoming out. Should I schedule the surgery now or wait a bit longer?
Is 3 Months Too Soon for Breast Augmentation Revision Due to Bottoming Out?
Doctor Answers 5
Capsulorrhaphy for breast implant malposition
Thank you for the question.
One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).
In your case, I would suggest repair of the inferior breast capsule with permanent internal sutures (capsulorrhaphy). I would suggest waiting at least 6 months after your last procedure. Capsulorrhaphy involves removal of a segment of breast implant capsule among the inferior/lower aspect of the left breast implant pocket. The 2 edges of capsule tissue are sutured to one another with permanent suture. This procedure reduces the size of the implant pocket and prevents the descent of the implant on the left side. Suturing to the ribs is not necessary and complication prone. This procedure will improve the symmetry of the breasts and the positioning of the nipple–areola on the left breast mound.
Make sure you're working with a well trained experienced board-certified plastic surgeon. Capsulorrhaphy, even in the best of times, is not always successful and further revisionary surgery including the use of allograft ( I use this material for cases of recurrent implant malposition) may be necessary.
I hope this helps.
How long to wait for breast implant revision surgery
If you breast implants have experienced "bottoming out" I would recommend waiting at least six months before having an attempt at a revision. You want the swelling to subside and you want some of the scar tissue to develop because that will be helpful in giving strength to the repair of your new inframammary fold (breast crease).
If you are more than three months out, you may be a candidate if the breasts are soft and things have healed up to undergo a revision.
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I think it is best to wait between 3-6 months before having revision surgery so that the swelling has resolved. If you really have bottoming out then you may benefit from repairing the fold with a dermal substitute (like alloderm). Good luck!
Breast implant malpositions
Do not assume it is from "over dissection of the pocket" as if it is the surgeons fault. All of us have had your problem if we do enough breast surgery. Give it 4-6 months and have the revision done but be sure not to ask to go bigger as some patients do.
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