Is my implant bottoming out? Is there anything I can do to help stretch the upper breast tissue?

Question

I am 39 days post op from smooth round silicone unders 304cc. I am worried as I see my lower pole stretch so much. I hate how it looks more full than the top. Can this go away as I heal? Can I do anything to help stretch the upper portion? Note that my new crease is 2-2.5cm below my incision. My ps did not alter my crease. Does this mean my crease may rise back up towards the incision? From my crease to the center of my areola is 10cm on left 11.5cm on right.

Harry T. Haramis, MD, FACS · Answer

You can try taping and bra support for the crease and lower pole. Gentle massage may help the pocket settle. Otherwise, a revision may be indicated, if desired, at some point in the future.Close follow up with your plastic surgeon is recommended to discuss your options and expectations.

Luke J. Curtsinger, MD · Answer

I am sorry that you're having trouble so soon after your surgery. It appears that the implant on the right side has pushed down the beneath the inframammary fold. Unfortunately, I don't think there any exercises that you can do to correct the situation. You should see your plastic surgeon and likely make a plan to correct this when the time is right.

S. Larry Schlesinger, MD, FACS · Answer

The very short answer to your questions are Yes and No.Yes, your implants are bottoming out and No, stretching the upper pole of the breast will do nothing to help the implants rise back up.If you had a double bubble with a tight inframammary fold, then releasing the upper pole would allow the fold to push the implant back upward.  I am sorry you are going through all of this.  It would appear your surgeon did everything right and things still went wrong.  Very often, bottoming out is due to laxity of the tissue below the inframammary fold which is probably true here.  The surgeon using too large an implant, which is certainly not true here, or failure to open the upper pole sufficiently so the implant is forced downward also doesn't appear to have happened here either.   If you were my patient, I would make an incision at the bottom of your areola, remove the existing implant, close out the bottom portion of the breast pocket by doing a capsulorrhapy or capsulopexy and add Seri, and open the upper pole of the breast implant pocket so there is space for the new implant.  At this point, it would be appropriate for you to set up a consultation with your plastic surgeon to discuss how your breast augmentation has progressed and work together with him or her to rectify your post operative situation.

Larry S. Nichter, MD, MS, FACS · Answer

Surgery is the only effective remedy. Revision surgery is almost always more complex than breast augmentation. Correction techniques vary based on your plastic surgeon’s experience and skill sets. Always choose a board certified plastic surgeon with expensive revision experience as even in the best of hands recurrence is frequent especially if larger implants are used. Repair techniques include some of the following techniques and recommendations:Textured implants (“Velcro effect”)Use of Smaller ImplantsMaximum Submuscular Position (not just the pectoralis major but abdominis rectus below and serratus anterior on the side)Capsulorrhaphy (tightening the pocket by sewing in-folded capsular tissue together)Use of Biologic fabrics and other materials such as Acellular Dermal Matrix, “ADM” Alloderm, Strattice, “Silk” and others that can be used to reinforce the bottom of the pocket.Change of position of implant to a new pocket location “neo pectoral pocket”Internal Ryan Procedure (sutures binding the inferior mammary fold to stronger underlying tissues (e.g. fascial, periosteal)Removal of Implants and replacement of volume using your own fat (Fat Transfer).

Keith Hodge, MD · Answer

Unfortunately, I think that you are correct in your assessment. Your implants are bottoming out. I suggest that you discuss this with your plastic surgeon. Surgical correction may be required. Good luck!

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.

From your photos, yes it does appear your implants are bottoming out.  I would recommend following up with your plastic surgeon to discuss your options.

The best way to assess and give
true advice would be an in-person exam.

Please see a board-certified
plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Vaishali B. Doolabh, MD, FACS · Answer

Hi LunaMarieee. Thank you for sharing your photos. It does appear as if your implants have lowered on both sides. Generally speaking, this necessitates a straightforward pocket adjustment to reposition the implants-twilight anesthesia and brief recovery. Talk to your plastic surgeon about a surgical revision-this is an opportunity to change your implants as well if you want more cleavage or volume. Good luck!

Michael M. Omidi, MD, FACS · Answer

Thank you for the question and photos.  Based on your photos, you may be bottoming out and an option you can try is wearing a sports or underwire bra to help support your breast but you may also be needing a revision surgery.  Best to follow up with your plastic surgeon for you concern.  Best of luck, Dr. Michael Omidi

James E. Hardy, MD · Answer

Hi and thanks for the question and photos. Unfortunately you do have some bottoming out of your implants. Maintaining support may help the process. You should communicate these concerns to your ps and likely you will need a procedure to repair this. Best of luck with your results...

Ciro Adamo, PhD, MD · Answer

At this stage you could try taping and/or an underwired bra, but it seems that you are right, and in all honestly that is unlikely to work and move the implants up. This will most likely need a revision, not a difficult one, and you should discuss the procedure with your surgeon.

Is my implant bottoming out? Is there anything I can do to help stretch the upper breast tissue?

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