Is my breasts bottoming out my fault or my doctors? Should I try a new doctor for my revision? (Photo)

Question

Hello! My breast bottomed out for the SECOND time and both times I went to the same doctor. He is kind enough to redo it a third time and we talked about adding galaflex this time around. He says my implant side is not that big at 300cc and that the reason this keeps happening is due to my skin. I do Not care about the cost, I just don’t ever want to do this surgery again… should i try a new doctor or same? Do you think this is all due to my skin? Please help.

Daniel Barrett, MD · Answer

Dear NYCGirl1010,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gerald Minniti, MD, FACS · Answer

If you looked like this prior to your first revision and didn't get resorbable mesh, then I believe it was an error in judgment on the part of your surgeon. Having said that, it appears you would have a stellar result if not for the implant displacement. It's up to you.

Gary M. Horndeski, MD · Answer

The strength of your skin is not adequate to hold up the skin envelope and implants.  At this time, I recommend taking out the implants and revising the scar in the inframammary folds.

Best Wishes,

Gary Horndeski, M.D.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. A large portion of my practice is dedicated to revision breast surgery. In your case, I would remove the redundant, inferior pole breast tissue perform an internal bra procedure-capsulorrhaphy, and revise the mastopexy. I perform this surgery very commonly. In fact, the name for this procedure is termed Reductive Augmentation. I wrote the first paper in 2017. Early in practice, I found that if I did not remove the inferior pole breast tissue, the breast would bottom out quite commonly. You should be able to have an excellent, long lasting results. Best wishes to you

Ronald J. Edelson, MD · Answer

It appears you had a vertical lift which left too much skin in the lower portion of your breasts. You need to have that excess skin removed by converting your lollipop lift to an anchor lift. It will entail an extra scar under each breast. It’s up to you to decide whether it’s worth it

Camille Cash, MD · Answer

I'm sorry that you are having issues with your implants bottoming out.  This is typically a result of poor skin elasticity or implants that are too large.  You should find improvement by adding mesh this time.  Though this appears to be the correct recommendation for you, there is no harm in visiting another board certified plastic surgeon near you for a second opinion.

Connie Hiers, MD, FACS · Answer

I agree with your surgeon. Your tissue is not supporting the weight of these implants. You do need to go smaller and use the internal bra of mesh for support. Please do not go larger.

Jason Pozner, MD · Answer

You need support internally. I cant comment on your previous surgeries without more info but I wont do a lift with implants without support these days - currently using galaflex. Make sure you see someone with mesh experience as placement can be a little tricky

Mats Hagstrom, MD (license on probation) · Answer

Most cosmetic surgical outcomes are based on two variables. The first is the patient’s candidacy for the procedure in the first place and the second is the skills and experience of the provider. When implants are placed correctly, leaving enough pectoralis muscle to secure, the implant position will not bottom out.
It can be , a bit of a juggle, getting implants to sit in the right position. in my opinion, it’s always better to lean on the side of having to revise a high writing implant, then dealing with bottomed out to implants.
Once implants have bottomed out, things tend to get worse with time so it’s better to deal With the problem sooner rather than later.
Choosing the right provider is pretty much half the equation when it comes to quality outcomes.
Finding the right plastic surgeon can be more difficult than most people in real life and the difference in skill and experience can vary substantially.
Being bored, certified in plastic surgery with years of experience, and an overall good reputation does not mean somebody has mastered anyone single procedure.
Generally speaking plastic surgeons who do a lot of the same procedure tend to get better at that procedure, but there are plenty of successful plastic surgeons who still do on the average work.
I generally encourage people to vent plastic surgeons by asking them to open up their portfolio and show you their entire collection of before, and after pictures of the previous patient who had similar body characteristics to your own for any recommended procedure.
If your surgeon is proposing to correct bottomed out implants, then you need to make sure that your surgeon has experience doing this with good success.
An experienced plastic surgeon should have no difficulty showing you the before, and after pictures of at least 50 previous patients for commonly performed procedures.
Most plastic surgeons I probably dealt with implants at some point in their career with varying success. The treatment for this condition is definitely not easy or straightforward. It is a complex procedure and getting long-term success requires skill and dedication.
This is true whether it’s done by using internal sutures or supporting the implant with mesh or cadaver dermal products like Alloderm. 
Blaming the patient is the oldest trick in the book, and I typically lose respect when surgeons are not willing to take ownership of their own work.
If a patient is not a particularly good candidate for a surgical procedure for any reason, and the talented plastic surgeon should be able to detect this and explain that to the patient during the primary consultation. This is also true for major complications and side effects, including discussing what the incidence of these conditions are, and how they’re treated. this is all part of proper informed consent.
I don’t know what part of the country do you live in but should you be close to Southern California? I know that Tom Pousti MD is very talented and extremely experienced plastic surgeon, especially regarding complicated issues regarding breast implants.
He’s also a prolific responder to patients questions on this website.
I generally encourage patient to have second opinion, consultations, whenever they have doubts or are seeking the best provider for their needs.
I generally encourage patient to have multiple consultations before choosing a plastic surgeon. for complex situation’s or operations I don’t have a consistent track record. I don’t think it’s wrong to have as many as five consultations or more. Especially when dealing with permanent irreversible operations. You are in a sense, hiring someone for a service and doing that generally requires interviewing multiple people to find the best person for the job.
Generally, speaking, repeat operations, make things more complex and difficult. The more revision someone has had the more likely they are to end up with undesirable outcomes.
There’s something to be said about letting surgeons to be responsible for their own outcomes, and maintaining continuity of care. Generally, that should be the standard.
In the end, your job is to find the most talented and experience provider for your needs.
The final decision will be yours.
Best,
Mats Hagstrom, MD.

Is my breasts bottoming out my fault or my doctors? Should I try a new doctor for my revision? (Photo)

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