My left breast has bottomed out, resulting in great asymmetry. What can I expect for my revision surgery? (Photo)
Doctor Answers 11
My left breast has bottomed out, resulting in great asymmetry. What can I expect for my revision surgery?
I am certain that you had significant asymmetry in your breasts before undergoing breast augmentation, and due to settling of the left implant this has been exaggerated. With you in a face-to-face situation and with your preoperative photographs available one can plan capsulorrhaphy, right periareolar mastopexy and exchange of implants in an attempt to improve your asymmetry. In a situation such as yours I think it is reasonable to explain that perfect symmetry cannot be expected but improvement should be sought. Good luck and best wishes,
Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California
Correcting Asymmetrical Breast Implants by Adjusting the Breast Pocket
It's difficult to determine without 'Before" photos. Creating a #Neopectoral #pocket is sometimes used as a technique to provide a stronger more secure placement for breast #implants. In this case, the implant is removed and the capsule is dissected from the muscle to create a new or “neo” pocket for the implant. However, any #asymmetries regarding the folds under the breasts may not be totally corrected. To better determine the technique and placement best for your revision, I suggest you see your board-certified surgeon to discuss in more detail.
What can I do about asymmetry of breasts?
Your breast asymmetry may not be due to the breast implants bottoming out. You should get another opinion. Reducing the size will do very little to correct this!
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Thank you for the question and the photos and you will need a pocket revision to obtain a more symmetrical appearance to your breasts as well as a possible implant change. Be certain your surgeon has a lot of experience in this area as changing the size of the implant alone will not correct the problem.
You can't correct your asymmetry by just dropping your implant size; you need to do a proper breast augmentation revision which will require you to adjust your implant pocket and decrease your medial lower breast pole prominence with an excision and will will require a mini lift on the right; to get your breast symmetric you need to have meticulous surgical planning and performance. Please see results below.
Revisionary breast surgery ( bottoming out) concerns…
I am sorry to hear about the complication you have experienced. Based on the photographs, I agree that revisionary breast surgery will help. This operation will likely involve capsulorraphy ( (adjustment of the breast implant capsules) and breast re augmentation surgery. You will find that postoperative "protocols" will vary. In my practice, I ask patients to limit upper body exercise for several months after this type of revisionary breast surgery. You may find the attached link, dedicated to this type of revisionary breast surgery helpful to you as you learn more. Best wishes.
Hello and thank you for posting photos along with your question. Pre-operative photos would be helpful here to see what the asymmetry in your breasts were before the surgery. However, of the question is mainly about the left breast....It does appear to be bottoming out. This is a risk that can happen after breast augmentation. There are many ways to fix this and depends on the surgeons success with a particular procedure. Some will use the patients native tissue to recreate the fold and some prefer using special biological implants to assist with reconstructing the lower breast crease AKA the infra mammary fold. The surgery can be pretty successful...In my opinion, I have seen greater success with the use of a type of scaffold that strengthens the repair. Going with a smaller sized implant is a good idea because that will decrease the stress on the reconstruction. Hope this helps and wish you the best of luck!
Ankur Mehta MD
Implant bottoming ouot
Thank you for asking about your breast implants.
- it does look as though your implant is bottoming out.
- This can happen if the breast crease is naturally weak or weakened by surgery.
- If by re-positioning the implant your surgeon means recreating the breast crease, the plan sounds a good one.
- Making it a little smaller will put less stress on the breast crease and make bottoming out less like to recur.
Always see a Board Certified Plastic Surgeon. Best wishes - Elizabeth Morgan MD PHD FACS
Thanks for the great question and the photos. An implant typically bottoms out with the connective tissue attachments to the fold have been disrupted and not repaired during breast augmentation surgery. There are other issues which can make bottoming out more likely to happen, such as having a very large implant. The patients natural anatomy is unable so support the weight of the implant and it moves.
If done properly, fixing a malpositioned implant should be pretty successful. There are a lot of different techniques which can be used to accomplish this goal. Without seeing you in person it is difficult to say exactly what may work best for you. The recovery from a revision surgery should be about the same or a little easier than the original surgery. Best of luck!
Bottomed out breasts
When a breast implant migrates below the original placement location with the bottom of the implant just above the infra-mammary crease, we call this “bottoming out.” There are several causes of this downward migration of the breast implant. Usually, some attempt had been made to lower the crease to accommodate a breast implant whose base diameter is larger than would otherwise fit in the natural breast. In doing so, the anatomic attachment of the skin of the breast to the chest wall can be obliterated. There is then nothing to hold the implant up. With the weight of the implant, and constant gravity, maybe lack of support by lack of wearing a bra continuously, the implant can settle downward. One of the earliest symptoms, I see in patients seeking revision,has been the feeling that the breast has to be constantly adjusted or just feels heavy. We look for the incision line, which was previously placed at the crease, to have migrated upward onto the breast. When we see this early on in the postoperative phase, it will never get better with time and will require a secondary repair. While some plastic surgeons may rely on suturing techniques only, I have found that unless we un-weight the implant by making it smaller or strengthen the tissues below by making them less stretchy, that the same implant, with just sutures placed on the bottom of the pocket, will, over time, recur it's bottomed out position. I have used part of the capsule as well as the lining of the deep muscles and tissues over the ribs in the capsule beneath the breast implants to rotate upward to hold the breast implant in a higher position and therefore obliterating the extra space that has been created between the correct infra-mammary crease and the one created by the downward displacement of the implant. I call this a three flap technique, as the skin, the capsule and fascia (lining of muscles), as well as a dermal flap all contribute to creating a hammock like support of the lower portion of the pocket. When these tissues are insufficient to hold the implant up, or a previous attempt has been made with sutures, I will oftentimes rely on the addition of another type of tissue called an acellular dermal matrix of which my preference is Strattice. This Strattice ,or pigskin, does not stretch and can be sewn in to the bottom of the new location of the crease to support it just like a hammock would. Although this is costly, I consider this an insurance policy against having to redo this again. I would recommend that you try and find a plastic surgeon with experience in revisionary cosmetic breast surgery. Good luck.
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