Headed to surgery soon, wanted other doctors opinions: Bottom out breast (textured or smooth). (photos)

The doctor is going to take the fluid out of my breast 2 weeks before surgery . He is going to tighten my poles , the bottom and the sides . I am unsure what implant I want, I am thinking textured so it does not move and reduces the chance of bottoming out but than I have read that textured increases rippling . Which implant would you go with. I believe I might do 350, I believe I had 375 saline before

Doctor Answers 5

About Breast Implants "Bottoming Out"

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"Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.

Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant.
This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold.

Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Revision breast augmentation for bottoming out

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Your skin appears to be kind of thin, which allows implants to stretch the skin and descend due to gravity. Usually, changing to a slightly smaller implant doesn't change the weight enough to prevent it from happening again. Biologic materials are a great way to support the implant and reduce the chance of bottoming out again. You're right that textured implants are more likely to cause visible rippling, especially because your skin is thin.

Malik Kutty, MD
Sugar Land Plastic Surgeon

Psuedoptosis Repair

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You do seem to have some bottoming out, which comes from violation of the most basic relationship in all of breast augmentation surgery, which is to select an implant that does not exceed the capacity of the patient's tissues to hold. Often violation of this balance is unintentional, sometimes it comes from a surgeon accepting a  size request from the patient that puts them at risk for the complication, and other times it is from unforseen weakness or laxity of the patient's own tissues.

So my first choice is to try and see if m,y patient will accept a smaller implant. Next, it's appropriate to consider ways to make the breast stronger after the deformity is corrected. This comes through use of sutures (capsulorraphy) and sometimes an acellular matrix "patch" or "internal bra" to help support the implant.

John LoMonaco, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 276 reviews

Bottoming out

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Thank you for the great question and the photos. I agree that your current implants have bottomed out. It is best to repair these either through creating a neosubpectoral (new pocket under the muscle) pocket for the implants or through performing a suture repair to support the lower portion of the breast. You may also need to have some skin of the lower portion of the breast resected to get the best aesthetic results. 

As for the implants, it doesn't really matter whether they are smooth or textured. The real important factor is that the repair is done properly to prevent this from happening again. Best of luck!

~Dr. Sieber

David A. Sieber, MD
San Francisco General Surgeon
5.0 out of 5 stars 40 reviews

Bottom out breast revisionary surgery..

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I am sorry to hear about the problem you have experienced after breast surgery.  As you mentioned, I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair).  In my practice, I have found the most success utilizing a two layer permanent suture "repair". Sometimes, depending mainly on the patient's history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh.

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.  

 Generally speaking, careful selection of plastic surgeon will be the most important decision you make. In my opinion, this type of revisionary breast surgery does require experience when it comes to achieving successful outcomes.  Again generally speaking, the decision to use smooth versus textured implants is not merely as important as careful selection of plastic surgeon, careful preop communication of goals and skillful execution of the procedure.

I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.

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.