How Can I Tell if My Implants have Bottomed Out? (photo)

I'm almost 6 months after my lift/augment. I have two concerns - 1) my nipples seem too close together (even to coming out of bras) - could this be fixed? 2) I'm a bit worried that my right breast has bottomed out (also right in picture, due to mirror), due to how much of the implant is below/to the right (outside) of my nipple. Does it appear to you that it has? Thank you.

Doctor Answers 9

Bottoming out? How to tell.

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Since you have had a full (Wise pattern or "anchor" pattern) breast lift plus implants, bottoming out is not just a function of implant position with regartds to the breast, but the design of the breast lift.

Your right lateral flap was drawn, cut, and sutured according to your surgeon's design and your measurements. It's easy for any of us (who didn't actually do your surgery) to be critical after the fact, but I'll try to word my assessment in a kind and gentle fashion. Not quite enough skin was removed on this side, and the weight of your breast plus implant has "filled" this excess skin more so than the medial. In other words, if you look at the inferomedial curve of you right breast, it is very close to parallel with the cure of the areola, whereas laterally, your inframammary crease drops down and away a bit too soon. Your left breast is better in this regard, which is why it looks better.

Also, your right nipple areola complex was positioned (by the design, marking, and cuts your surgeon made) just a bit too far medial (towards the center) than ideal, and a bit more than the left, as measured from the midline. Your nipples should be about 21cm (see Dr. Johnson's answer; he references a study done by Dr. Penn in the 1950s about breast anatomy and measurements) apart; this means that each should be 10.5 cm (or so, but equally) from the midline. Both look a bit close; your right more so than the left.

What this does is allow your nipples to show in some necklines, and contributes to the "too much breast to the side" appearance that makes the breast look bottomed out on that side. Imagine if your right nipple was a centimeter or so more to the side--this would give a much better looking breast that might not even look bottomed out. But compared to the left, the malposition of the nipples contributes to the asymmetric appearance. If you click on the link below, you can see that all patients have some degree of slight asymmetry in nipple position, both before, and after, surgery. But, lateral is usually a bit better than too close to the center, since the chest curves and "proper" nipple position points a bit to each side, not straight forward.

All of this, again, is simply to discuss how one would go about improving your appearance. The nipple/areola conplexes cannot be "lowered" much without scars where they are now, but additional skin excisions and finessing the pattern can improve your result. Yours is not a bad result, but it could be better, and if you discuss this with your surgeon in a friendly and collaboratively way rather than an angry or accusatory way, I suspect he or she would be happy to make some (surgical) adjustments for minimal operating room costs, and they could possibly even be done under local anesthesia to further reduce the costs of revision.

Talk to your surgeon! If you don't like what you hear, there are probably many other fine ABPS-certified plastic surgeons who can help, but at additional cost. Best wishes!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

How Can I Tell if My Implants have Bottomed Out?Answer:

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I feel there is bottoming out when there is a lot more of your breast below your nipple than above it and that does not seem to be the case from your pics. BUT, a simple answer to you other question is if your nipple is popping out then it is too high! While I think your nipples may be too high, I don’t feel that it is because of bottoming out but rather from higher placement. Unfortunately,  it is very hard to lower a nipple, much easier to raise one.

John J. Corey, MD
Phoenix Plastic Surgeon
4.7 out of 5 stars 48 reviews

Breast Implants Are Bottomed Out When The Nipple Areola Is Above The Breast

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Thank you for your question.

It is too early to tell if you are going to bottom out. Wait 6 months to see your final result, you may be fine.

You can tell that your Breast Implants have Bottomed Out when the Breast mound is below the Nipple Areola complex and the Nipple Areola appears too high and points upward

Breast Augmentation and Lift - ? Bottoming Out

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As has been suggested widely there are few procedures as complicated as a breast augmentation (implants) and a lift simultaneously, even to the extent that some surgeons have started staging the procedures (ie, they do the lift first, and then wait several months and do the implants).  While I believe that the procedures can be combined this does underscore the complexity of the combined procedure and predicts that higher-than-average potential to need to have a revision at some point in the future.  This makes sense, since the two procedures rely on and produce opposing forces - the implants push the skin and breast tissue down and out, the lift pushed them up and in.  A setup for imperfection!

And without knowing what you looked like before it is difficult to assess the degree of improvement you have.  In the end, though, if you're not happy with the result you should have a calm and reasoned discussion with your PS to see what can be done about it.  Needing to reposition and implant or revise a scar is a relatively small procedure in the scheme of things, and seeking a resolution with your own PS will be the most expeditious way to accomplish your goal.  More complicated procedures may simply not be worth it in view of the benefit you've already achieved.  But that's a discussion you'll need to have in person.

I hope that this helps, and good luck,
Dr. E

Breast implants too low, or nipple too high

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Your instincts are right, and your nipple is too high and inside after your mastopexy augmenation 'coming out of bras'. The nipple is most often at the midhumeral line, and forms an equalateral triangle from the top of the breast bone, nipple to nipple (Penn's triangle). Of course everyone is different and not 'ideal' you might look better an have an easier time with clothing if the nipple is moved down and out a bit. This is not easy to do, so seek a very experienced surgeon if things don't sort out.

Best of luck,

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

How Can I Tell if My Implants have Bottomed Out?

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Looking at your pictures, I wouldnt state that your breast implant has bottomed out.  If however your nipple areola complex shows in your bra or bathing suit, then the implant may be sitting a little low, or the nipple areola complex may have been placed a bit high.  I agree that your NAC look close together.  These issues can be improved with revisional surgery, relocating the NAC more lateral and suture fixation to place the implants higher in the pocket.  Good luck!

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 109 reviews

Breast Augmentation/Breast Lifting Results?

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Thank you for the question and pictures.

Both of your concerns are visible in your pictures. Both can be corrected with revisionary surgery if the concerns are significant enough. For example, the  positions of the nipple/areola complexes can be moved laterally to some degree.  Sometimes reducing the size of the areola may also be helpful for patients in your situation. Permanent suture repair (capsulorrhaphy) may be helpful to correct the right breast implant displacement.

I would suggest continued follow-up with your plastic surgeon to express your questions and concerns.

I hope this helps.

Bottoming out after Mastopexy-Aug

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First, I'm not exactly which is your "right" after your explanation with the mirror. That being said, it looks like the breast on the right (as you look straight at the photo), what I would normally consider your anatomic left breast. It may be that your nipples are a bit too high, but not by much, and it is very difficult to lower a nipple without leaving a visible scar above it. I would suggest that the implant is actually too low and towards the outside (down and out). If it were "pushed up" higher and towards the center does it seem to make the whole breast better? This would be a much easier type of revision as the capsule just needs to be tightened (perhaps the space made a bit bigger towards the center, but beware of symmastia). The other breast looks pretty good but has a milder case of the same. if the implants are submuscular, be careful not to do much upper chest exercise/weights for six weeks after the revision. The muscle can push the implants out where there are now.  

Bottomed out

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It does not appear that the implants have bottomed out and in fact they appear to be settling. Preoperative photos and measurements would help but ultimately, you will likely have a very nice result. 

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.