Bottoming Out? Managing expectations (Photo)

Question

I’m 5’6” 135lb with athletic build. I had very thin skin and very little breast tissue (32AA) with a chest split from lifting and the desire for a more feminine look. I ended up getting 450 cc high profile silicone under the muscle implants 7 years ago. Since then, I had 2 pregnancies and breastfed two babies. My current weight is what it was at time of implants. Now, I believe the implants have bottomed out and are heavy. What can I expect if I choose to explant? Will I need a lift?

Wess Cohen, MD · Answer

Thank you for your question. the breast tissue that you have is going to be even less than you had pre-implantation. Overtime and after breast-feeding, the breast volume droops, and also decreases in size. With that being said, you will need a lift or else you will be extremely flat with loose hanging skin. In order to improve the shape and add some volume you can choose to either put in another small, implant or add some fat grafting, or even combine the two techniques. Good luck.

Daniel Barrett, MD · Answer

Dear saraaa_,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Jeffrey Lisiecki, MD · Answer

It depends how thin the breast tissue over your implants is if you could get/would benefit from a lift at the time of explantation.  You don't have ptosis now, but will almost certainly have some loose skin after implant removal.  A great alternative route that might decrease the need for a lift (and retain some fullness in your breast after the implant is removed) would be to fat graft your breast at the time of explanation.

Alan Gonzalez, MD, FACS · Answer

Hello @saraaa_, thank you for your question. The outcome depends on what you want and what you discuss with the specialist.  If you choose and explant the prosthesis will be removed and total capsulectomy must be perform to avoid inflammatory processes in the future (even if you do not have BII symptoms, is better to be safe). After removing the implants, in my patients I perform an aesthetic breast reconstruction with the BRALAN technique (Breast Reconstruction Anatomical Lift Augmentation) to improve the upper part of the breast and the middle part and produce better projection of the upper pole of the breast. So the patient will have anatomical shape with less breast volume.    To shed more light on this, I have attached a video. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS),   International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

Finny George, MD · Answer

Hi, thank you for sharing your question. It is possible that your implants have shifted lower in your breast pocket but it is hard to confirm solely based on photos. An in person complimentary evaluation may be beneficial.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  it does not appear that you have bottomed out but you likely have had stretching and settling of your natural breast tissue.  Most likely if you completely remove your implants you will require a lift to remove the excess skin, but best to seek out in-person consultations to get the best advice.

Shana Kalaria, MD · Answer

It is best to visit in person, but from the last photo it is suspicious for implant rupture because of the irregularity of the implants. Usually the implants are smooth and round, but yours appear to be irregular in shape along the bottoms of the implants giving them a more rectangular shape. This is usually easier to tell in person and can be detected on mammogram or MRI. I would recommend just removal of the implants now and being open to the idea of a lift with auto-augmentation in the future if you are unhappy with how they look. Please visit in-person with a board-certified plastic surgeon. Good luck!

Connie Hiers, MD, FACS · Answer

You might want to consider going down in size and tightening your inferior and lateral pockets. If just removed, you will be very flat with sagging skin.  You may not have enough tissue under your nipple to allow a lift.  Your tissue, however, is not supporting the weight of these heavy implants. Consider going down to 300 cc's.  Remember, you were not happy with your breasts prior to surgery and may not be happy once removed.

Camille Cash, MD · Answer

It does appear from the photos submitted that your implants are bottoming out.  If you elect to have the implants removed the skin will retract to a degree.  However based on the information and photos provided it is likely that a lift would be indicated in order to correct shape and remove excess skin.  I encourage you to visit with a board certified plastic surgeon near you for an in person evaluation.

Peter Andolina, DO · Answer

After looking at your photos and reading your post, I think what has happened is that your native breast tissue is falling off of the implant.  This is most likely due to your pregnancies and breastfeeding.  If you choose to remove your implants your breasts will be very flat and saggy and you will most likely need a lift.  I do not think you will go back to your pre-op size but you will be considerably smaller than you are now.   All in all I think you will have a nice result because based on your photos you have a small frame.

Bottoming Out? Managing expectations (Photo)

Answers (10)

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