Bottomed out? (Photo)
Doctor Answers 9
I am sorry to hear about the complication you have experienced.
Revisionary breast surgery to correct breast implant bottoming out which will likely involve capsulorraphy ( internal suture repair). Sometimes, depending mainly on the patient's history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh. 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.
Key will be careful selection of plastic surgeon; success with these types of revisionary breast operations are experienced dependent in my opinion. In other words, make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with this type of revisionary breast surgery.
I hope this, and the attached link and video (dedicated to corrective surgery for bottoming out concerns), helps. Best wishes for smooth pregnancy, happy/healthy newborn, and eventual revisionary breast surgery outcome that you will be very pleased with.
Bottoming out can occur for several reasons.
It can be successfully repaired by a plastic surgeon familiar with the repair techniques
Thank you for your question and photos. Yes, it can get worse but is unpredictable. The hormones of pregnancy alone will make your tissues more stretchy in preparation for delivery, so this can get worse, especially during pregnancy. There is not much you are able to do other than perhaps wearing a support bra. Revision surgery such as this is a bit more complex than the first augmentation and thus the cost is often a bit higher. It's definitely worth the fix though!
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Revision Breast Surgery
No one can tell you if it will get worse. I suppose it doesn't matter. You need to visit a few ABPS certified/ASAPS member surgeons that specialize in revision breast surgery. It is a longer, more complex surgery. Given the likelihood of a more senior surgeon performing a more difficult and lengthy operation, you can be assured it will be more expensive, unfortunately. You might consider just removing your current implants under local anesthesia so that they don't do more damage. Best of luck!
I am sorry to see your surgical outcome which often reflects attempts to place too large an implant in the skin envelope that is available. This generally can be dramatically improved by capsulorrhaphy, but in your case of course you need to wait until completion of your pregnancy and breast-feeding. I would highly recommend that you wear an underwire bra as much as possible including even while asleep to prevent further descent. You will need to be reassessed before surgery after completion of your pregnancy to see if any other procedures need to be considered such as a breast uplift. Going to a smaller implant along with undergoing capsulorrhaphy will give you the best chance for a permanent improvement. Revision surgery in your case would be more complex than the original breast augmentation and seeing a new surgeon I would expect the cost to be similar to your original breast augmentation. Best wishes,
Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California
Implant bottomed out?
Thanks for your question-- congrats on your upcoming addition! Almost all physicians are going to recommend to you, as I will, to focus on your health and the health of your baby. But at some point after the postpartum changes are complete, (and after you catch up on lost sleep) you will probably want to look into a revision. The photo you submitted does show bottoming out of the implants, fairly symmetrically on both sides. Your surgeon may have tried to lower the fold beneath the breasts to accommodate the larger implant. However, with this loss of support, implants are prone to descend further down the chest than they are supposed to. To fix this, you would need sutures along the lower pole to reposition the implant. Adding a mesh to the lower pole can reinforce the area and help prevent this from happening again. Also, a smaller, lighter implant is less prone to bottom out like this. Finally, you'll want to see what effects pregnancy has on the breasts, you might need to consider a lift at the same time (not just raising the implant, but raising the implant and tightening the skin around it.) Revision surgeries are more difficult, and often take longer than the augmentation, so most of the time they cost more. Discuss this with your plastic surgeon to determine your best options.
Best wishes with your pregnancy,
Erik Hoy, MD
Rhode Island Plastic Surgeon
Congratulations on the new family member that is on the way. Wear a well supporting bra and I doubt you will have any further progression of the problem. The cost issue is not one we can answer as fees vary so much around the country, but probably not far from a standard augmentation. It probably costs more to see a new doctor than to go back to the original surgeon, but I think you are choosing wisely.
Implants bottoming out
You certainly have bottoming out of your implants based on your photos. There are a variety of reasons for this including over dissection/lowering of the breast fold and poor capsule formation. Prices for revisional surgery vary from location to location and can be more than your original surgery depending on what needs to be done. This can get worse with time. Wear a good, supportive bra, especially when you are doing physical activity.
Bottoming out of the Breasts
You DO have bottoming out of the breasts. This happens as a combination of the use of a breast fold incision, over dissection of the bottom pocket either by the surgeon or by you ( by not wearing a bra and allowing the implants to undermine and and push they way lower) and as an inevitable act of larger implants and of gravity.
There is nothing that needs to be done now as your breasts sizer is still changing. Correction of the implant pocket should be done about 6 months after you are done breasts feeding and or your breasts stopped producing milk and have returned to s stable shape. At that time you may require a pocket correction and a possible breast lift.
Peter A. Aldea MD