Bottomed out with textured implants?

Question

445cc-495cc mentor memory shape implants, textured anatomical cohesive gel silicone submuscular. 6 mos post op. I bottomed out with textured but i want rounds bc i have no upper pole. What will happen if I switch to smooth walled implants with capsulorraphy?

Paul E. Chasan, MD, FACS · Answer

I have some very specific thoughts for you. In many people bottoming out after primary breast augmentation cannot be prevented due to the size of the implant and the strength of the tissues. That being said, once a capsule has formed around an implant, it can be used to bolster the implant by suturing the pocket - capsulorrhaphy.  Capsulorrhaphy is very effective at elevating the breast mound and improving the look of bottoming out. Once you have an established capsule and remove a textured implant, there is no benefit to placing another textured implant. It appears that you want more upper pole fullness, so I would go with a smooth round device. I hope this helps.

Jed H. Horowitz, MD, FACS · Answer

"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.

To manage scars following the procedure, I suggest #scar maturation products to my clients. Such as BioCorneum or Embrace, to name a few, are recommended. But, it's best you wait a few weeks following your surgery, to begin using them and speak to your surgeon about healing concerns

To manage scars following the procedure, I suggest #scar maturation products to my clients. Such as BioCorneum or Embrace, to name a few, are recommended. But, it's best you wait a few weeks following your surgery, to begin using them and speak to your surgeon about healing concerns

Larry S. Nichter, MD, MS, FACS · Answer

Revision surgery is almost always more complex than breast augmentation. Correction techniques vary based on your plastic surgeon’s experience and skill sets. Always choose a board certified plastic surgeon with expensive revision experience as even in the best of hands recurrence is frequent especially if larger implants are used. Repair techniques include some of the following techniques and recommendations:Textured implants (“Velcro effect”)Use of Smaller ImplantsMaximum Submuscular Position (not just the pectoralis major but abdominis rectus below and serratus anterior on the side)Capsulorrhaphy (tightening the pocket by sewing in-folded capsular tissue together)Use of Biologic fabrics and other materials such as Acellular Dermal Matrix, “ADM” Alloderm, Strattice, “Silk” and others that can be used to reinforce the bottom of the pocket.Change of position of implant to a new pocket location “neo pectoral pocket”Internal Ryan Procedure (sutures binding the inferior mammary fold to stronger underlying tissues (e.g. fascial, periosteal)Removal of Implants and replacement of volume using your own fat (Fat Transfer).#bottomingout#breastaugmentation#BA

Ronald J. Edelson, MD · Answer

Yes, you have bottomed out a bit and thus is why I don't like so called anatomic shaped implants.  They're too bottom heavy.  Capsulorraphy is one option.  I would replace the implants with smooth round ones.  Another option is to perform a lift as well, but that involves more scars.

Gerald Minniti, MD, FACS · Answer

Hello,Thank you for re-posting with photos!  Nice timeline photos too. If you like the way you looked (your upper pole) early on, then you should stick with your current implants. If you want even more upper pole fullness you could do one of two things: Switch to MH 495 cc - 555 cc Mentor Memory shaped implants, which have the same width as your current TM+ 445 cc-495 cc, but with a more aggressive upper pole, or  go to smooth HP 500 cc - 550 cc.  You are taking a bit of an increased risk of recurrence by going to smooth considering your propensity for making wispy scar capsule. Although you really look great right now, I can understand how you feel you're a little bottom heavy and missing fullness on top. Best of luck!

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.You are bottoming out with textured implants and don't have upper pole fullness. I would most likely recommend a smaller implant with a dermal matrix support.This could be anatomic or round but would be best to examine you.The best way to assess and give true advice would be an in-person exam.Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.best of luck!Dr Schwartz

Stephen Bresnick, MD · Answer

Patients who are "bottoming-out" are showing evidence that their breasts are having trouble handling the weight of their implants.  Textured devices are less likely to bottom out in my experience than smooth, and if your implants were textured, one has to be cautious in selecting the next implant.The best plan for you will likely include tightening your pocket (capsulorraphy) as well as reinforcing your pocket with a strengthening material such as Seri Surgical Scaffold.   Seri helps reinforce the capsulorrhapy for a long-enough time that collagen and healing can support your implants.   If your tissue is too thin to use Seri, Strattice can be used.Hope this helps!Dr. Bresnick

Steve Laverson, MD, FACS · Answer

Your outcome after capsolorrhaphy and implant exchange depends on many factors, and nobody I've known can predict the future with certainty.  Your skin's response to the new devices, their size, weight, internal support, positioning, and your post surgical activity level and the bra you wear (type and duration) may all influence your result.  Achieving the exact result you want is an individualized process conducted with your surgeon.

Donald R. Revis Jr, MD · Answer

Good evening!I agree you will look a lot better with round smooth High Profile silicone gel implants. I would also perform the Internal Bra, my strong permanent internal suturing technique that lifts your implant pockets higher on your chest wall and closer together, giving you better cleavage and upper pole fullness, and supports your new implants over the long term. This is the most common revisionary procedure I perform, about 4-5 times a week. It works and it lasts!I have attached a link to my Internal Bra / Breast Augmentation Revision photo gallery for your review- hope it helps!

Michael J. Brown, MD · Answer

Hi,

Thanks for posting your question. I am happy to try and help you. It is
important to remember that a board certified plastic surgeon will be your best
resource when it comes to an accurate assessment of your situation, and
concerns.

Having said that,it is common to have implants settle at different rates. If
your pre-existing anatomy has your breast creases or breast folds at different
positions, they implants will settle to different places. So your preoperative
anatomy has a lot to do with a final result. You may always have some minor degree of asymmetry. You should be prepared to accept some degree of asymmetry.