5'2/105 lbs 295cc submuscular round implants. right one bottomedout had revision capsuloraphy but fell back (photo)

BA in November 2014. My revision surgery was in June 2015. Noticed immediately that they were uneven, but I knew it takes time for it to settle. My doctor wants to redo the capsuloraphy sugery using "heavy duty" stitches. I am skeptical. I have almost come to like what I call my "floppy boob" better, I like the tear drop shape and I would love to get slightly bigger (325cc) tear drop implants put in if my surgeon was opened to the idea...is there other suggestions to fix a bottomed out implant other than another capsuloraphy?

Doctor Answers 3

Not bottoming out

I must respectfully disagree with my colleagues.  Without seeing your pre-operative photographs I don't know if your left breast was lower than your right, your right breast was lower than your left or they were both even. 

However, your photograph shows that your left breast is lower than your right.  A capsulorrhaphy, in my hands is not a sturdy enough repair to restore the inframammary crease (the fold where the breast attaches to your chest).  There are several techniques to raise the inframammary crease.  Some of the techniques include placement of an artificial skin (ADM), scarpa's repair Ask your plastic surgeon what he/she thinks would work best in his/her hands. 

As far as going with a larger implant, I would not do that at the same time as the repair because it will put undue stress on the repair.  Get everything restored to where it should be and then  increase the size of your breasts. 

Breast implant revision

There are a number of options available to treat bottoming out. Capsulorraphy, or suturing the inferior capsule, is one option. This may be combined with removal of a portion of the capsule which is know as a capsulectomy. Another option is to create a totally new pocket. This can be done by changing a sub muscular pocket to a sub glandular pocket or vice versa. Finally, an allograft such as Alloderm (human cadaver skin) can be sewn into the pocket to precisely define the limits of the pocket.

Personally, if I had done a capsulorraphy once and it did not work I would consider another alternative.

Sanjiv Kayastha, MD
Albany Plastic Surgeon
5.0 out of 5 stars 68 reviews

Bottoming out after breast augmentation…

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.

I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). 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. Also visibility of the inframmammary fold scars should improve with this operation.

Whether or not to use your existing breast implants will be very simply determined; if they achieve your desired outcome in regards to breast size/shape, then more than likely you can utilize the same implants. If not, the use of the appropriate size/profile of breast implants will not be necessary to achieve your desired outcome. In my practice, this is best determined using intraoperative sizers during surgery after careful communication with the patient prior to surgery.
Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery.
I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

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.