2nd revision needed - bottoming out 8 months post-op? (Photos)

Question

I had my original breast lift/Aug in October 2021, about 6-8 months in I mortise my nipples were higher, implants lower, Could feel/see rippling. Went back to my original surgeon and we scheduled a revision for Oct 2022. We exchanged the implants, resecured/tightened everything, and did an internal bra. I’m now 8 months post revision and am experiences all the same issues. Have an appt with original surgeon soon, but wondering what could be going wrong & what can be done.

Gianfranco Frojo, MD · Answer

It is difficult to provide an adequate comprehensive answer without additional information such as size of implant placed, position of implant (above/below muscle), and doing a physical exam. It appears that the implants may be in a subglandular/subfascial position. I would recommend performing a pocket change to a submuscular pocket with an appropriate sized implants and then performing another lift. Complex breast surgery requires a highly trained plastic surgeon, ideally with at least of 6 years integrated plastic surgery training followed by an accredited aesthetic surgery fellowship. I highly recommend finding one of those if possible.

John Michael Thomassen, MD · Answer

The inframammary fold is not holding up the implants as evidenced by the inframammary fold scar now being present on the anterior surface of the breast.  This can be fixed with sutures but it may recur.  To avoid this, you may consider smaller implants to put less stress on the repair as well as mesh support.

Daniel Barrett, MD · Answer

Dear rkgs0502,
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

Connie Hiers, MD, FACS · Answer

Your implants are too large and heavy for your tissue and are sagging from the weight. You need to go smaller.

Douglas Taranow, DO, FACOS · Answer

Your surgeon may consider revision of the bottom of the pocket with ADM (acellular dermal matrix) placement (products like Strattice or Alloderm), or possibly removing skin at the bottom of the breast and incorporating the old scar into the excision (this may work only if the implant is not lower than the other side).
Best wishes,
Dr. Taranow

2nd revision needed - bottoming out 8 months post-op? (Photos)

Answers (5)

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