Implant bottomed out 3 years post-op? (photo)

Question

I’m a 27F and I got under the muscle silicon breast implants three years ago. A couple of weeks ago the underside of my breast where my scar is started to be uncomfortable/tender and sometimes hurt, it has now moved up to being that way constantly and the area is bigger that is uncomfortable/hurt. Has it bottomed out?, my nipples definitely have become more uneven.

Finny George, MD · Answer

Hi, thank you for sharing your question. It’s difficult to diagnose the exact problem with photos alone but the implants seem to be malpositioned and this could be due to a number of things that may require surgery to correct, including a capsular contracture.

Donovan Rosas, MD · Answer

Post Op asymmetry is common and often is a function of the degree of pre-op asymmetry. Remember "sisters...not twins"

Bottoming out is a phenomenon which occur secondary to failure of the fold at the base of the breast. The fold can give way naturally (especially in the case of a large volume augmentation) or can be disrupted via surgical approach. The hallmark for bottoming out is an implant which falls below the crease. This can often times be noted by upwards migration of the fold access incision.

Based upon your photos, it is difficult to say for certain that you have bottomed out. Both scars lie slightly above the fold. However, this is only an issues if you have noted a change over time.

As always. discuss your concerns with a board certified plastic surgeon (ABPS).

Ted Eisenberg, DO, FACOS, FAACS · Answer

Always best to check with your surgeon, if possible, as your surgeon knows how you started and what was done. Otherwise, an in person exam by a plastic surgeon and a history of what was done is needed to answer your question. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., US

Daniel Barrett, MD · Answer

Dear ryms,

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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ira H. Rex III, MD · Answer

I cannot tell from the photographs at all what is happening.  You should probably see your plastic surgeon to help you through this new situation.  Good luck.

Camille Cash, MD · Answer

From the posted photos it does not appear that your implants have bottomed out.  I encourage you to visit with your surgeon to discuss the discomfort you are feeling and the changes with nipple symmetry.  It could be anything from irritation from a bra, fragrance, etc to capsular contracture so it's best to be evaluated by your surgeon.

Connie Hiers, MD, FACS · Answer

Yes, you have some bottoming out and sagging. You will need to go smaller so that your tissue will support the weight. You are not supporting this weight now.  Adding implants  stretches and thins your own tissue which decreases support.

Mats Hagstrom, MD (license on probation) · Answer

I think there are a couple of issues that need to be addressed if you want an improved outcome.
At this point, I think you need a breast lift.
Secondly, I don’t think your implant is still sitting under the muscle.
The implants look like they’ve slipped down and this is probably contributing to the result. 
When placing the implant under the pectoralis The muscle needs to be at least partially cut.
Ideally, enough of the pectoralis muscle fibers should remain intact to support the weight of the implant.
If too much of the muscle is cut, then the implant can drop below the muscle from gravitational force or contraction of the muscle itself.
 This is generally what a bottom implant is.
This outcome is part related to how the procedure was done, and it also correlated with the size of the implant.
If you have faith in your provider, then go back and see him or her for a second procedure.
Alternately consult with other providers to see what they have to say.
For second opinion, surgery or revision surgery come prepared to bring with you a complete set of proper before and after pictures and a copy of your previous operative report.
 Those are part of your medical records that you can request from your provider.
Surgeons are obligated to keep medical records for a certain number of years and they should still be available for you if you request them.
Always bring before and after pictures and a copy of your previous operative report when getting a consultation from another surgeon.
I think for sure you’re going to need a breast lift.
In order to have a quality long-term outcome the implants are going to need to be properly supported.
The number of waste this can be accomplished, but you should for sure confirm that the surgeon who does your procedure has experience managing implants that have bottomed out.
 The chance of this problem recurring is significant.
Provider selection is the most important variable.
Avoiding excessively large implants would be the next most important variable.
Finding the right provider is not at all easy or straightforward.
Bring pictures of yourself to use as reference and ask plastic surgeons to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had the same problem or breast characteristics.
Best,
Mats Hagstrom MD

Implant bottomed out 3 years post-op? (photo)

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