Am I bottoming out? Lateral malposition? (Photo)

The best person to ask the question to is your surgeon who knows exactly the technique used and work done.

Bottoming out refers to migration of an implant below the level of the native fold. This will typically occur if the fold has been violated during the placement of the device.

Some signs include upward migration of an incision which was originally placed in the fold. The NAC may also appear to rotate upwards as the distance between fold and nipple lengthens with tissue stretch.

Based on your photos, the left breast shows mild downward migration. It may not progress from this point. However, if further migration occurs surgical revision may become necessary.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Dear Caring694564,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hi there! It does appear that your left implant is below your incision which is a good indication that the implant has migrated lower than anticipated. This is a subtle “bottoming out” as you were referring to. A pocket repair and use of internal bra scaffold can help repair this concern! I would return to your plastic surgeon and see what they think or offer

This could be easily addressed with horizontal skin excision to make the nipple to fold distance equal on both sides. It appears that the scar planning was a bit too high. The scars have now displaced on the lower pole of the breasts (worse on the left than right). There is also a slight "bottoming out" of the left breast, which could be reinforced at the time of the excess skin removal with the horizontal resection.

It does seem like your left implant is positioned somewhat low. You could consider returning to your plastic surgeon for and evaluation and an opinion whether a small revision surgery is appropriate.

I see what may be the slightest difference in your breast base width and the fold laugh is perhaps a tiny bit lower than the fold on the right.

Overall this is an excellent result in my opinion

This is well within the of natural asymmetry that every woman has. The photo that would help the most would be your preoperative photo which most likely shows there's a tiny bit of difference between the breast folds, the amount of skin, or the amount of breast tissue.

I try and make a pointof demonstrating this in front of the mirror to my patients since mild asymmetry is guaranteed after just about every breast surgery.

It looks like your implant may have migrated a bit. I would recommend that you set up a time to meet with your original surgeon to discuss these changes and explore options.

From your photos it does appear you are beginning to bottom out. It's best to visit with your surgeon for an evaluation. This condition can be corrected surgically.

You do appear to have the start of implant migration inferiorly. This can be corrected with a simple procedure involving tightening internally of the breast implant capsule called “capsulorrhaphy” or internal bra. The procedure would take 30 min and I would recommend doing a little on both sides.