Left breast bottomed out. Which procedure is best for revision? Sutures only or sutures with ADM? (photo)
Doctor Answers 10
When capsulorrhaphy alone doesn't work for bottoming out
Bottoming Out / Internal Bra Repair
I perform a lot of Internal Bra repairs for Bottoming Out- about 5-6 per week, and most do not require an ADM. I usually reserve it for those patients who have had a failed repair before I met them, or for those with extremely thin tissues. Since it is expensive, I would rather examine you before making you commit to the ADM. The ADM is not without its own set of complications as well, so if you can have a successful repair without it that is best.
I have attached a link to my Breast Augmentation Revision / Internal Bra photo gallery for your review- hope it helps!
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When one is lower than the other
Implant is a bit bottomed out... What now?
Great question, 3 possibilities:1. Capsulorrhaphy to raise implant. My best one is with cautery in the segment to eradicate it, slight over correction, use long term but not permanent suture (like PDS)2. Back up plan, if I get in there and you have a paper thin see through capsule I can see right through... ADM from muscle to proper location of crease. Again mild over correction as adm stretches by about 20%3. Crazy idea, lower your right side a bit to match. Really depends here on your preferred aesthetic. Advantage of that is that it's a two minute surgery and I would try to talk your original surgeon into it. ;)
Treatment for bottoming out with breast implants.
I want you to be very careful about your next surgery, as you are entering into the breast revision stage, which for everyone should be done one time, but frequently several surgeries are done. So, do your due diligence and pick a great surgeon who you like and trust - preferably your first surgeon. I just hate it when folks get into a vicious cycle of needing revisions. Since your IMF is now obliterated and your implant has bottomed out, you need that anatomic structure repaired and often reinforced, as you mentioned. A capsule revision (capsulorrhaphy) would be needed, although even this on its own can sometimes break down, especially with big heavy implants. If I'm concerned, I will often use ADM, especially one that doesn't get more lax over time (e.g. Strattice) and place this at the IMF to act as a sling, and this should hold it in place hopefully forever. Good luck!
Left breast bottomed out. Which procedure is best for revision?
It is possible that you are feeling the implants significantly along the lower poles of the breasts. Also, consistent with the breast implant positioning problem, the nipple areola complex seems to be sitting relatively high, because the breast implant have settled too low.
I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). 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.
In my practice, this type of repair involves a two layer, permanent suture repair (reconstructing the inframammary fold areas). Sometimes, depending on the clinical situation and history, the use of additional support materials such as acellular dermal matrix or biosynthetic mesh is also helpful.
I would suggest that you communicate your concerns again directly with your plastic surgeon. Working together you arrive at the best plan (for example to operate on one or both breasts) to achieve an outcome that you will be happier with. Make sure that he/she has significant experience with this type of revisionary breast surgery; experience does matter with these types of operations.
I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.
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