Is this my pocket created or am I bottoming out 14 days post op? (photos)

I'm now 14days post op - I understand still very early if in my healing. My left breast has caused me trouble however today whilst massaging I noticed my left implant is sitting slightly below my incision. Is this the normal feeing of the pocket been created or am I bottoming out/ double bubble? I have made contact with my surgeon yet awaiting their reply, i can feel it more than photos are showing. 14days post op 365 HP under muscle gel implants

Doctor Answers 2

Breast Augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

No- you are not bottoming out. Your implants will settle and may be below the incision after you have finished healing and it will depend on your infra mammary fold. Your preoperative breast size and where the fold was will play a role in where your new fold will end up with the 365cc implant. Generally with that size implant the fold will end up being 7-8 cm from the nipple. This being said you need to be patient in the recovery process before making any judgement on your result. Good Luck 

Paramus Plastic Surgeon
5.0 out of 5 stars 11 reviews

Subtle signs of bottoming out is normal and expected.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

From your pictures, it does not look like you are experiencing bottoming out. However, you are experiencing subtle signs (i.e., incision travelling up onto the skin) which is common as the implants starts to drop. It is important for you to understand that the incision is on the skin, and the skin stretches as the implant drops, but this does not necessarily mean that the breast fold which was at the site of the original incision has been compromised.

To better inform you, here is some information about bottoming out.

Bottoming out is common when the inframammary fold is released and not firmly sealed and reinforced.

A weak inframammary fold will result in downward breast implant displacement once the breast implant slips below the natural or surgically lowered inframammary crease overtime.

Clinical signs:

  • Bottomed out implants end up too low on the chest wall with the inframammary scars travelling up onto the breast skin.
  • The nipples will not only point upward, but also be positioned higher on the breast mounds.
  • There will be no pain, but you may notice thinning of the skin at the bottom of the breast, which will allow you to more easily feel the breast implant.

It is good to be wearing supportive bras as this prevents further bottoming out. Supportive bras will apply upward pressure to the fold at the bottom of the breast.

To correct “bottomed out” breasts, a surgeon would need to secure the implant in an elevated position and then reinforce the implant capsule at the bottom of the breast with a suture technique. There may be a need for Acellular Dermal Matrix, a soft-tissue graft, in the repair. A smaller implant is often advisable, if the original was too large. In fact, receiving an implant larger than indicated by your breast characteristics and boundaries increases the risk of malposition. 

Please continue to have regular follow-ups with your surgeon to make sure your breasts are healing. Their recovery instructions should take precedence over all else you read here as they are better informed about your surgical details.

Hope this helps.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 521 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.