Am I bottoming out? Should I have this pain? (photos)

Question

I had my breast augmentation on May 4th. Everything is going pretty well, recovery wise. I am concerned about my left implant bottoming out though. It feels like its falling too low and is painful at the bottom when gravity is pulling it. (when I am up and walking around). I know they will drop at different times, so I am not worried about the right one still being higher. I am only two weeks post op, so I am not trying to rush anything. I just feel uncomfortable w/ how the left one sits/feels.

Daniel Barrett, MD · Answer

Dear ashfitgirl1,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

Christopher V. Pelletiere, MD · Answer

Since you are only two weeks post surgery, it is always difficult to assess implant positioning.  However, from your picture it does appear that your one side is sitting lower and causing a double bubble effect.  I would wear a bra that really supports that side while healing and continue to allow yourself to heal.  The three month mark would be the appropriate time to address the positioning of new be.  I hope this helps.

Robert M. Tornambe, MD · Answer

ashfitgirl1.  I appreciate your concerns but way too early to worry. Your implants are pretty large and your body needs time to heal and adapt to the implants. The skin and muscle over the implants must stretch a bit to allow the implants to settle into their final position. While your appearance will improve fairly quickly, don't expect to see your final result for at least 6 months after surgery. Good Luck!

Ven Erella, MD · Answer

Thank you for your question. This look like double bubble.  Please talk to your PS. Your pre op pics will help. I recommend to wait 3 months and re evaluate as they settle with time some time.

Tuan A. Tran, MD, MBA, FACS · Answer

Thank you for sharing your pictures.  You have “double bubble” deformity.  It is stil a little bit early to re-interven.  Would recommend to return to your board certified plastic surgeon for counseling.  Thank you and best wishes

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast augmentation surgery. 
It looks like you have "double bubble" and breast implant bottoming appearance after surgery. A "double bubble" is a cosmetically undesirable circumstance for patients with breast implants, which occurs when the breast fails to take on the shape of the implant, resulting in the appearance of a visible line showing a separation between the bottom edge of the implant and the bottom edge of the natural breast.   Double bubble "deformities" may be more striking (visible) when breast implants have bottomed out.Sometimes, in situations like yours, the appearance of the breast improves over the course of the first several months; sometimes, additional surgery may be necessary to improve the outcome.

If revisionary surgery becomes necessary, one maneuver that may be helpful is raising the inframammary fold using capsulorraphy techniques. In my practice, this type of repair involves a two layer, permanent suture repair (reconstructing the inframammary fold areas). 
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.
Sometimes, depending on factors such as quality of skin along the lower breast poles, additional support provided by acellular dermal matrix or biosynthetic mesh may be very helpful. I have also found the use of acellular dermal matrix very helpful in cases where the skin/tissues are very thin and in cases of recurrent breast implant displacement. The acellular dermal matrix helps improve contour, improves irregularities caused by the underlying breast implant and/or scar tissue, and provides additional support ("sling" effect) for the breast implants.
 
I hope this  helps.
Best wishes.

Marc J. Salzman, MD, FACS (retired) · Answer

From your photographs, it does appear that you have a double bubble on the left side. Without seeing your preoperative photo, it's difficult to assess what the cause might be. A supportive bra during the first month or so after surgery may help alleviate this. I would recommend you follow the instructions of your chosen plastic surgeon who knows you best. Best of luck.

James McMahan, MD (retired) · Answer

Thank you for your question and photographs.  Bottoming out is a gradual stretching of the skin from the bottom of the areola to the inframammary fold (IMF), which happens due to loss of elasticity of the skin, pressure from the implant or a combination of both.  Double bubble is caused by the bottom of the implant sitting below the IMF; the crease between the two bulges is the natural IMF.  To resolve this issue, the implant has to be repositioned above the fold and the fold must be reinforced with sutures.  You can help preventing worsening of the condition by differential wrapping with an Ace bandage; wrapping it with some pressure above the right breast and below the left.  Best wishes.

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