Will my revision results turn out better or worse? Should I revise bottoming out? 6 year old implants (Photo)

Question

I want to go bigger from 375cc smooth mod plus to 500cc mod plus. Should I fix the scar placement? Is this a complicated surgery even for an experienced Plastic surgeon? Should DR leave scar placement alone and just go bigger? The placement of implants on chest wall is perfect I think. It's just the scar is very visible and probably Even more if they use the same scar to put a bigger implant in. Should The scar be tucked in the crease? Will I loose significant lower pull fullness? Is fixing the scar placement risky? What would you do? I've been to a few consultations and all doctors want to tuck the scar and add internal bra but I'm scared the lose lower fullness what to do help!

Gianfranco Frojo, MD · Answer

Increasing implant size will only make the problem worse. I would recommend performing an inferior mastopexy (eliminating the excess breast tissue/skin below your old scars). This will help shorten the nipple to fold distance and improve the bottomed out look. The implant will always stretch out the lower pole, which is why scar planning is so important. Surgeons will normally just place the scar in the existing breast fold at the time of surgery (which is incorrect and will lead to displaced scars on the lower pole). I would highly recommend finding a highly trained aesthetic plastic surgeon (preferably 6 years of dedicated plastic surgery residency and 1 year of aesthetic fellowship). Best of luck!

Daniel Barrett, MD · Answer

Dear evangeline jamie,
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

Farbod Esmailian, MD · Answer

Judging by your photos it does appear that you have slight bit of bottoming out.  This is not really because of how the scar has come up but more so the position of the NAC.  You would benefit from a capsulorrhaphy during the revision surgery.  That will bring the scar down a bit as well.  But the main reason of having the capsulorrhaphy performed is because of the NAC position not the scar.
As far as a larger M+ implant goes, I would want to know the measurements before I up size a patient, specially upsizing in the same profile.  I would think that the M+ in a 500 cc implant would be a tad wide but again we dont know your breast measurements.

Hope that helps.

Shana Kalaria, MD · Answer

Your bottoming out and scar will certainly worsen with larger implants. I would not recommend going much bigger if you can avoid it. Larger implants will make bottoming out worse and puts lot of pressure on the breast fold and incision. Please visit with a board-certified plastic surgeon. Good luck!

Bruce K. Smith, MD · Answer

If the breast implants were initially placed under the pectoralis major muscle, it is apparent that they now have pushed out from under the muscle and are essentially on top of the muscle. Revision would best be performed by enlarging the pre-pectoral pocket and placing the implants totally on top of the muscle with recreation and elevation of the inframammary fold supported by mesh. Mesh should be used to prevent recurrent bottoming out even after removing the muscular force that caused the implant to displace inferiorly and stretch the fold. This is a great example of what happens when patients have sub-pectoral implants (under the muscle) and continue to perform gym activities that work the pectoralis muscle. Mesh will also be necessary to support the larger implant desired. Good luck to you.

Connie Hiers, MD, FACS · Answer

Your implants are too heavy for your tissue and are sagging from thinning your own tissue and the weight. You need to go smaller and have the inferior pocket repaired, possibly with mesh, to keep support.  I would use the same scar since the pocket needs to be addressed. Please do not go bigger or you will sag even more.

Ralph M. Rosato, MD · Answer

The scar is visible because the breast implants are now below the original breast fold. (Botteming out) If a larger implant were to be placed it would expose more scar.

In my opinion the original fold needs to be repaired. Placing a larger (heavier) implant will stress the fold repair.  I would consider repairing the fold and not increasing you implant size. The implant in the proper position may have enough upper  pole fullness to make you happy with the shape.

Hilton Becker, MD · Answer

You already have problems with your implants ,I would not recommend going any larger.
The fold should be fixed with mesh support

Richard P. Rand, MD, FACS (retired) · Answer

You have bottomed out implants and that is why they sit low and the scar rode up. Most would say to fix that but you will lose the look you seem to like. So, if you want the same lower pole look, just go through the incision and don't repair the lower pole. Also, you cannot go from a 375 up t a 500 mod plus because it will be too wide for you. But you can go up to a HP without changing the diameter so much.

Will my revision results turn out better or worse? Should I revise bottoming out? 6 year old implants (Photo)

Answers (9)

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