When a breast
implant migrates below the original placement location with the bottom of the
implant just above the infra-mammary crease, we call this “bottoming out.”
There are several causes of this downward migration of the breast implant.
Usually, some attempt had been made to lower the crease to accommodate a breast
implant whose base diameter is larger than would otherwise fit in the natural
breast. If not done correctly, the anatomic attachment of the skin of the
breast to the chest wall can be obliterated. There is then nothing to hold the
implant up. With the weight of the implant, and constant gravity, maybe lack of
support by lack of wearing a bra continuously, the implant can settle downward.
One of the earliest symptoms, in my patients, has been the feeling that the
breast has to be constantly adjusted or just feels heavy. We look for the
incision line, which was previously placed at the crease, to have migrated
upward onto the breast. When we see this early on in the postoperative phase,
it will never get better with time and will require a secondary repair. While
some plastic surgeons may rely on suturing techniques only, I have found that
unless we un-weight the implant by making it smaller or strengthen the tissues
below by making them less stretchy, that the same implant, with just sutures placed on the bottom of the
pocket, will, over time, recur it's bottomed out position. I have used part of
the capsule as well as the lining of the deep muscles and tissues over the ribs
in the capsule beneath the breast implants to rotate upward to hold the breast
implant in a higher position and therefore obliterating the extra space that
has been created between the correct infra-mammary crease and the one created
by the downward displacement of the implant. I call this a three flap
technique, as the skin, the capsule and fascia (lining of muscles), as well as
a dermal flap all contribute to creating a hammock like support of the lower
portion of the pocket. When these tissues are insufficient to hold the implant
up, or a previous attempt has been made with sutures, I will oftentimes rely on
the addition of another type of tissue called an acellular dermal matrix of
which my preference is Strattice. This Strattice ,or pigskin, does not stretch
and can be sewn in to the bottom of the new location of the crease to support
it just like a hammock would. Although this is costly, I consider this an
insurance policy against having to redo this again. I would recommend that you
try and find a plastic surgeon with experience in revisionary cosmetic breast
surgery. Good luck.
Bottoming Out after Breast Augmentation Treatment
Although an exam would be required to offer a specific opinion in your case, it would appear the the main issue you face is bottoming out and not drooping (ptosis). Therefore the appropriate treatment would be to reconstruct you inframammary crease in its original position (for example using an internal Ryan procedure). That would not require a breast lift incision. Also helpful would be textured implants and placing them in a submuscular pocket to minimize re-bottoming out
It sounds like you need a lift of some sort, and yes the skin may stretch out due to poor quality. Hard to say without an exam.
I am sorry to hear about the problem you are experiencing after breast augmentation and revisionary surgery. Based on your description, it seems like you are experiencing a breast implant displacement problem.
Generally, the "bottoming out" breast implant displacement problem can be corrected using an internal suture technique (capsulorraphy) along with the use of acellular dermal matrix orbiosynthetic mesh.
My best suggestion: make sure that your selected plastic surgeon has a significant/demonstrable experience achieving the types of outcomes you will be pleased with.
I hope this, and the attached link (dedicated to "bottoming out" breast implant displacement concerns) helps. You will find a separate page, on the same website, dedicated to the use of acellular dermal matrix. Best wishes.