Bottomed out! Is mesh/internal bra the best fix? (Photo)

Dear jswinfrey,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Thank you for your question. A large portion of my practice is dedicated to breast surgery and revision breast surgery. I have been in practice for over 28 years. I totally disagree with the above answers. In your case, you would benefit from an internal bra procedure - capsulorrhaphy. I wrote the very first paper on capsulorrhaphy over 20 years ago. I find that many surgeons are not skilled at this procedure and have high rate of recurrence. You should be able to have an excellent result. Best wishes to you

Your breasts are wider than your chest wall. This may result from large base implants. If this is the situation then you will need smaller based implants. I would recommend smaller volume as well as internal support laterally and inferiorly and the pockets need to be created larger on the top to make the implants higher and more medially.

Best Wishes,

Gary Horndeski, M.D.

The actual problem is that your implants are too large and heavy for your now stretched and thinned tissue. I would suggest going smaller. Mesh could be helpful. Just removing excess lower skin may not raise up the implant and skin does stretch.

Based on your one posted, photo appears one breast has bottomed out while the other one is on the borderline. In my opinion, this is best addressed in your situation by breast lift or breast lift revision to tighten the skin envelope. In addition, mesh can be added at a larger expense with more complications. This should be discussed in a virtual consultation.

When implants are placed correctly, the gravitational pole is supported by the pectoralis muscle and connective tissue in the infra mammary fold.
When these tissues are violated during augmentation, the patient is at risk for bottoming out.Simply put if the surgeon doesn’t have the skill to place the implants correctly the first time they’re probably not the right surgeon to fix the problem.
Correcting bottom out implants is technically challenging and should be done by those who have sufficient experience with the procedure.
The repair is typically done using either internal sutures closing the pocket and this can then be reinforced using either mesh or cadaver dermal products.
Look for plastic surgeons, who have extensive experience with breast augmentation surgery especially those who spend a significant part of their career doing breast, cancer reconstruction.
Breast, cancer reconstruction all aspects of cosmetic surgery under complex conditions and the surgeons who do a lot of reconstruction tend to be really good at these procedures.
Sufficiently experience provider should be able to show you a significant number of before and after pictures of previous patients who’ve had this deformity and have it corrected with long-term success.
If it’s not done correctly the condition, will Rick her quickly.
The condition will continue to get worse unless it’s corrected so it’s better to have it fixed well sooner rather than later.
To get a proper second opinion consultation come prepared to bring with you a complete set of proper before and after pictures and a copy of your previous operative report.
These are available from your current providers office if you request them.
You may want to request a copy of the entire medical record, but the most important aspect are the operative report And all before and after pictures.
I generally recommend patients have multiple in person consultations before selecting a provider.
For primary breast augmentation, ask providers what their most common reason for revision surgery is, what their revision rate is, and what their revision policy is.
Ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar body characteristics to your own.
An experience provider should have no difficulty showing it before and after pictures of at least 50 previous patients.
Being shown a handful of pre-selected images, representing only the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider.
There are three variables to determine the outcome of breast augmentation surgery.
The first is the patients candidacy for the procedure.
The second is the selection of implant in regards to size shape, and type.
The third variable is the ability for the surgeon to place the implant in the correct anatomic position.
of all these variables, the one the patients have most control over is provider selection.
There’s no correct number of consultations needed to find the right provider.
Sometimes it’s simply luck.
That said, patience should make a solid effort and take responsibility for vetting each provider recognizing that being board-certified and plastic surgery does not mean somebody’s mastered every procedure.
There are substantial differences in skill and experience among providers, regardless of credentials.
Best,
Mats Hagstrom, MD