I saw board certified PS in my area regarding BA. He said my natural anatomy is that I have "bottomed out" breasts and implants would only accentuate this. There is no way for me to achieve the upper fullness and roundness that I desire. He said I have more than avg tissue in the lower 1/2 of my breast creating a greater than avg distance from the nipple to the fold no implant will give enough up top and instead will increase the bottomed out look. Is this true? 5'2 107lbs 32C 27"ribcage 12BDW
Natural Anatomy - Bottomed Out Breasts?
Doctor Answers 19
Thank you for the photos. They are helpful. You do have greater fullness below the nipple than average. You also have asymmetry. It is possible to augment your breasts and provide increased fullness above. It will require some planning to determine the best sized implant to do this. I would suggest that you consider addressing the asymmetry as well-the Right Breast and nipple are lower than the Left and it is unclear from the photo but the Right breast may be larger as well. Please discuss this carefully with your surgeon so you understand what can be done to try to meet your expectations.
Breast augmentation together with breast lift
The desired proportions are 20cm from the notch above the breast bone to each nipple, 7cm from the nipple to the crease under the breast and 10cm from the midline to each nipple. Without a ruler in the photo or a face to face examination these measurements cannot be discerned from just your posted photos. However it is clear that the nipple to crease distance is more than 7cm which can create a bottomed out look. It is not clear how much over 7cm it is though because raising your arms in the photos distorts this area of measurement. The way to treat this vertical excess is to remove a horizontal ellipse of skin just above the crease. You can simulate this by pinching the skin in this area to get an idea of the effect. You could do that (breast lift) with or without placing breast implants. If you just have breast implants placed there is a significant chance they will make this current condition worse especially if you have large implants placed.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
Potential to have great results
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It is possible to increase the 'pseudoptosis' look you have if you insert too large of an implant. I would recommend a conservatively sized implant OR fat grafting instead of an implant. Fat grafting may be a good option for you. Be sure to see a board certified plastic surgeon in your area.
I dont think you have bottoming out. You have a very normal appearing breast anatomy. Breast implants that correspond to your breast width will give you the most natural look after surgery. They will fill the upper part of your chest where you are looking for more fullness.
Breast implants to create upper pole fullness
Breast implants are ideal in creating upper pole fullness in most patients. Based on your photos, you are also a good candidate. However, careful size selection and implant placement is necessary in order to achieve optimum results and minimizing complications such as bottoming out of the implant. I recommend seeking the opinion of another board certified plastic surgeon experienced in breast augmentation.
Trust the Professionals
I tend to agree with your surgeons opinion.
Fairly large implants placed slightly above the natural fold may give you the fullness you desire but if the implants are to large your bottoming out can get worse.
Bottoming out after Breast Augmentation
it looks like you are in excellent shape. I cannot tell how low the nipples are. You could be a candidate for transaxillary breast augmentation and inframammary skin/tissue resection. Get a second opinion but from the pictures I think a small breast implant would do well. Bottoming out is exacerbated with large, heavier implants.
Leo Lapuerta Jr. MD
Triple Board Certified Plastic Surgeon
Bottomed out breasts
There is no question that you will get closer to your desired breast image by using an implant. Depending on the size volume you want when you are done, the exact procedure can be modified to get the result you want. You need to get a second opinion from a board certified plastic surgeon. Enjoy. Jon Sattler, MD, Board Certified Plastic Surgeon, Glendora , CA.
Breast Augmentation in Patients with Low Lying Nipples
The important question to resolve is whether your nipples are higher than your inframmary fold (truly high nipples), or whether you have gladular pseduptosis (the nipple height is at the level of the fold but the breast tissue lies low and sags. If your nipple truly lies high you would be a candidate for carefully placed implants. If you have glandular pseudoptosis, you may require a breast lift that reduces lower breast skin and tightens the lower breast, but doesn't raise the nipple. This can be done alone or with an implant if you wish to increase fullness.
In the aesthetically ideal breast, the nipples are located approximately 1/3 the distance from the fold to the top of the breast. another guideline is that the nipples should lie at at mid-humerus (the upper arm bone).In your pictures, your nipples do seem a bit high realtive to the base of the breast. Unfortunately, the first 2 pictures are taken with "animation", with your pectoralis muscles tightened. Since you are very musclular this may raise the relative height of the nipple. I would like to see pictures of you, at rest, with your arms at your sides, straight on, 3/4 view, and sideways.
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.