Breast Aug with Failed Revision- Why does this keep happening? What options do I have? (photos)

Question

Last year I had a breast augment that resulted in slight bottoming out. 304cc silicone submuscular. I had a revision (capsulorraphy) 3/3/16 and am noticing the same signs of bottoming out. I am wondering why this keeps happening? Is it because I did light upper body workouts (no chest) after 6 weeks? Is it weak tissue? What are my options to keep my implants up like they were at 4 weeks post revision? I don't like my areolas so high on the breast with such a bottom heavy look. Please advise.

Tom J. Pousti, MD · Answer

I am sorry to hear about/see the problems you are having after revisionary breast augmentation surgery. I think your concerns are appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”). I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation. Whether or not to use your existing breast implants will be very simply determined; if they achieve your desired outcome in regards to breast size/shape, then more than likely you can utilize the same implants. If not, the use of the appropriate size/profile of breast implants will not be necessary to achieve your desired outcome.  In my practice, this is best determined using intraoperative sizers during surgery after careful communication with the patient prior to surgery.Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery. 
I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.

Shlomo Widder, MD · Answer

Dear Luna,   Thanks for submitting your before and after pictures and sorry for your problem.   From observing your pictures, it appears that your surgeons used the infra mammary incision for entry . This entry incision , makes it very difficult to correct well and consistently the excessively low sub mammary crease.   I have been in practice for 29 years, and based on my experience with many situation like your, In my opinion,  the sub areola incision is much better approach to perform inferior capsulorrhaphy (internal bra ). That is because the procedure can be done under direct vision !  Additionally, not all results are the same, because experience and skills are critical for good outcome.  Another possible reason for the bottoming out is superior pole capsule contracture , that is pushing the implants downward. In that case, superior capsulotomy ( scar release ) is indicated, in order to prevent recurrence.    Medial capsulotomy will be needed too,  for giving you a much nice cleavage, which, again, can be done easier through sub areola incision.    Always, consult with experienced board certified plastic surgeons who do lots of redo breasts augmentation in accredited  surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive.                         Best of luck,                                           Dr Widder

Donald R. Revis Jr, MD · Answer

Good evening!You do have a significant amount of bottoming out, and when patients come to me after a failed repair it is usually lack of experience that caused the problem- not using the correct sutures, not using enough of them, not placing them in the correct tissue layers- or some combination of those problems.  The correct 
repair is the Internal Bra, my strong permanent internal suturing 
technique which corrects your bottoming out. This is the 
most common type of revision I perform, 5-6 times a week- it works and 
it lasts!I have attached a link to my Internal 
Bra / Breast Augmentation Revision photo gallery for your review- hope 
it helps!

Steven Wallach, MD · Answer

It would be nice to know what type of capsule repair was performed.  Often suturing the capsule inferiorly helps and I like to use a thong bra. Sometimes strattice can help reinforce the repair.

Douglas Taranow, DO, FACOS · Answer

LunaMarie,Thanks for your question and for the photos.  Sorry your revision surgery failed.  You need an internal permanent suturing of the inframammary crease.  This should support the breast implant and restrict the downward progression.Best of luck.Dr. T

Breast Aug with Failed Revision- Why does this keep happening? What options do I have? (photos)

Answers (6)

Answer: Revision surgery

Answer: Revision surgery

Answer: Breast augmentation Bottoming out

Answer: Breast augmentation Bottoming out

Recommended reading

Everything you need to know about Breast Implant Revision

Our mission is to create a world where every investment in modern beauty is Worth It.

Breast Aug with Failed Revision- Why does this keep happening? What options do I have? (photos)

Answers (6)

Answer: Revision surgery

Answer: Revision surgery

Answer: Breast augmentation Bottoming out

Answer: Breast augmentation Bottoming out

Browse related questions

Recommended reading

Everything you need to know about Breast Implant Revision

Our mission is to create a world where every investment in modern beauty is Worth It.