6 months post-op and wondering if I am starting to bottom out (Photo)

Question

Exactly 6 months post op-340 cc, high profile gel, over the muscle.. I am wondering if I am starting to bottom out. My nipples look higher to me, maybe even the right more than left. I went to see my surgeon last week and he seems defensive that I was there checking.

Gianfranco Frojo, MD · Answer

This is a common result after subfascial/subglandular augmentation because there is minimal coverage/support from the pectoralis muscle. The distance from the nipple to fold will increase as the implant starts to exert its effect on the soft tissues. The absolute nipple to fold distance increases in a majority of breast augmentations (there are a few caveats).

Stanley Castor, MD · Answer

I think your implants have settled lower on your chest, which they will do over time. When the implant settles, it will push the nipples higher. Bottoming out is more common under the muscle. With bottoming out, you would see the implant sitting below your breast fold. Sometimes this is called a double bubble. So, I don't feel that you have bottoming out. An in-person exam is always best to tell for sure. Hope that helps!

Miguel Mota, MD · Answer

Hi! You are not bottoming out, your implants are just settling. I believe the issue is the implants are a little large for you so the surgeon had to make the pocket bigger… bigger on the upper and lower half of your breasts. Considering what your surgeon did your results are good and as expected. If you would’ve opted for a breast lift with implants (even a slight lift but with slightly smaller implants) you wouldn’t be having these apparent issues. 
A revision with a donut lift will help with nipple positioning. But your results are good for now. If you don’t want the extra scars, I do not think it would be worth it now. I suggest you wait some years before doing a revision.
Best of Luck,
Dr. Miguel Mota

Brian May, MD · Answer

Hi sashley2000, it appears that you have a lovely result at this time! However, from the photos, it is somewhat difficult to assess whether your implants are beginning to show signs of bottoming out.
"Bottoming out" refers to when the implants begin to fall below your natural breast crease. Without being able to see your implant position related to your incision and native breast crease it is difficult to say if you're having some early descent of the implants. If you have concerns, I would recommend scheduling a follow-up with your surgeon for an examination and to discuss your concerns. Best of luck!

Daniel Barrett, MD · Answer

Dear sashley2000,
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

Yes, you have some mild lowering of your implants, but nothing that should be treated surgically. However, do wear a good supporting day during the day.  Since you chose to place the implants in front of the muscle, you don't have much supporting these girls.

Camille Cash, MD · Answer

From the posted photos it does not appear that you are bottoming out.  The breasts appear to be healing appropriately and there is no obvious sign of concern.

Serkan Kaya Ekinci, MD · Answer

I couldn't see any problem, I can say that your surgeon did a great job and you have wonderful breasts. I don't see any problem that you should be worried about.

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