Augmentation revision options? Bottoming out and other issues (Photos)

BA in 2010: 575cc each, HP saline & placed through TT incision (bad decision in hindsight). Told pre-op by several doctors I have tuberous breasts (I'm not concerned with that). Pre-op completely flat; little breast tissue. Puffy areolas were the only thing protruding from chest. Want revision with smaller implants (no HP - they project too far forward),not opposed to silicone & incision placement doesn't matter. Don't want ADM/Strattice. Is there hope for me? These hurt, nips stick out of bras.

Doctor Answers 13

Augmentation Revision Options?

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Yes, trying to do a difficult (tubular breast) augmentation with a large HP saline implant through a TT incision was pretty much guaranteed to bottom out. And Yes, there is hope! Using an inframammary incision and switching to a new generation highly cohesive silicone gel implant with a lower profile and smaller volume has a very good chance of giving you a nice outcome. I would also suggest a textured surface implant which will adhere to your tissues and therefore allow you to avoid ADM/Strattice while at the same time minimizing the risk of recurrent bottoming out. Once the implant position is moved up the nips will no longer peek out above your bra.

Breast implant revision for 'bottoming out'

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I think your only real option is a breast augmentation revision with a biomaterial like Strattice or Seri - your implants need internal support and a stable infra-mammary fold needs to be reconstructed. This will be a complex revision. A scar along the infra-mammary fold would be necessary if I was performing this procedure.

Bottomed out implants

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There is definitely hope for you.  Your breasts can be revised with smaller implants without ADM.  You should consult with a Board Certified plastic surgeon.

David S. Chang, MD
San Francisco Plastic Surgeon
5.0 out of 5 stars 4 reviews

Lots of options exist for bottomed out breasts

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and you now must decide on just what yo wish to achieve and that will determine what procedure would be recommended.  Going smaller would make your revision easier.  You could get by without artificial materials if you want.  And you will have to wear a cut out bra 24/7 for 6-8 weeks to help support whatever repair you have.  Schedule your consultation and find out your options after you make sure your surgeon is aware of your goals.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Augmentation revision options? Bottoming out and other issues

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I commonly treat this type of problem with conversion to a pre pectoral pocketIt will correct the bottoming out and  reduce the pocket size

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Internal bra options for recurrent bottoming out

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Although ADM's such as Strattice have a long clinical record of success in revision breast surgery, there are newer options to consider such as Galaflex mesh. Smaller implants will help but with the degree of stretching and thinning of the skin envelope around the implants that you appear to have, internal support will greatly increase the chances of a stable long-term result.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Revision Breast Augmentation

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Hello,You would benefit from either a capsulorrhaphy or a neo-subpectoral pocket. ADM is not necessary, however the use of a bio-resorbable mesh might improve capsulorraphy results. Always an inframammary incision. Go visit a few ABPS certified/ASAPS member surgeons that specialize in revision breast surgery.Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Lower Pole Stretch

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This is a common issue. My initial plan would be to use an IM fold incisions, tighten the lower pockets, change to moderate profile plus implants and possibly remove skin at the folds. I would use ADM secondarily if the original tightening fails. Good Luck!

Brian Klink, MD
Vacaville Plastic Surgeon
5.0 out of 5 stars 100 reviews

Augmentation revision options?

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Yes, you can have your revision without ADM and should have a successful outcome, but in the event you do not, then later addition of ADM will be necessary. You need to have the capsules widely opened in the top of the breasts to provide room to reposition the implants upwards. The lower space needs to be obliterated with capsulorrhaphy. These procedures can be done either through fold incisions or incisions around the lower margin of the areolas. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Augmentation revision options? Bottoming out and other issues.

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The most reliable treatment for your bottoming out, assuming that your implants are already subpectoral, would be to create a new or "neo-subpectoral" pocket that is appropriately positioned...higher, a bit more lateral, etc...and close off your old pocket. This could be done without an ADM like Alloderm or Strattice, which you say you want to avoid. If your old capsule is extremely thin, it may help to reinforce it (and thus help your implants to hold their position and decrease the risk of recurrence of the bottoming out) with a temporary mesh such as Galaflex. I would perform this through an inframammary incision for proper access and the lowest risk of capsular contracture. Smaller moderate profile implants, as you say you would prefer, would not be a problem. Release of your sub-areolar constriction from underneath may be sufficient, but if your areolae remain "puffy", then a periareolar "telescoping" technique could be performed, which would leave a scar around the areola. 

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.