Chest muscle causing bottoming out? Will I need a lift and replacement? (Photo)

Question

I had 520cc implants placed in Sept and ended up having tacking done on one breast 8 weeks ago. When I flex my chest muscle the left (lower) breast seems in a better position. Is it possible an under developed left chest muscle is causing is to sit lower? Unfortunately…my fear is I need a lift and replacement with smaller implants at this point to be symmetrical.

Daniel Barrett, MD · Answer

Dear Fearless738593,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

Your breasts are wider than the chest wall and are mechanically unstable. At this time, I recommend smaller implants with a circumareola lift to reposition the nipple-areola complex to make them more symmetrical.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

You are bottoming out on the left, so I recommend going smaller since your tissue is not supporting this heavy implant. You may also need mesh.

Mats Hagstrom, MD (license on probation) · Answer

Breast augmentation outcomes are generally based on three variables.
The first is patient candidacy.
The second is implant selection and the third is the surgeons ability to place the implants in the correct atomic location.
To make an accurate assessment regarding the outcome of any plastic surgery procedure, we need to see a complete set of proper before and after pictures.
If you don’t have before and after pictures and ask your surgeon to forward the pictures they took.
If we don’t know what you look like before the procedure then we can’t assess the outcome of your surgery. We have to know what you look like before the operation.If you’ve had more than one procedure, then we generally need to see before and after pictures for each of your previous operations.
It would also be important to know if your implants were placed above or below the pectoralis muscle.
I’m guessing your implants are below the muscle since contracting. The muscle is changing the shape.
Most people have a left breast that sits higher on the chest wall than the right side.
On most people the IMF is about 1/4-1/2 inch higher on the left side.
This varies from person to person, but generally, the left breast always sits a bit higher.
Unless your picture is reversed, your left IMF is lower than your right.
I see no indication for you needing a breast lift.
If your IMF was opened excessively on your left, then you may be experiencing your implants bottoming out a bit.
Perhaps that’s what the revision surgery was aimed at correcting?Whenever selecting implants that are larger than the natural breast diameter, the chance of having undesirable side effects, complications and need for revision surgery will always go up.
Implant selection is an important part of the process and patient should be careful and avoid excessively large implants.
It doesn’t seem like your implants are excessive, but without having complete access to all the information it’s difficult to give you any good Suggestions. 
Whenever patients are unhappy with breast augmentation outcomes, we can almost always address the problem based on the three variables that determine breast augmentation outcomes.
The problem is almost always related to patient candidacy, implant selection, or the surgeons ability to put the implants in the correct position.
In your case, I’m guessing that there is an issue with the placement of your left implant and that your surgeon may have opened the IMF possibly to correct for normal asymmetry?
To get a quality assessment, we need quality information.
If you’re not getting the care you need from your provider then I suggest scheduling a few in person. Second opinion consultations with other providers in your community.
For second opinion consultations come prepared bringing with you a complete set of proper before and after pictures for each of your previous operations and copies of your operative reports.
These are all available from your current providers office if you request them.
Best,
Matt Hagstrom MD.

Chest muscle causing bottoming out? Will I need a lift and replacement? (Photo)

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