After capsulorrhaphy am I bottoming out again? 2 months post op. (Photos)

Question

I’m 2 months post op from having a breast pocket revision after getting implants that bottomed out from over dissection of my original breast crease. I had my original surgery in August of 2017. I had my revision in the beginning of May 2018 and now I’m wondering if my left implant looks like it’s bottoming out again? The first 4 pictures are from 2 months after the revision and the next is 2 days after and the last is from before the revision

Thomas A. Mustoe, MD, FACS · Answer

Your left implant is slightly lower, but still in good position aesthetically.  You will not know for sure how successful the capsulorraphy was for 6 months, but unfortunately recurrence of bottoming out can occur, and why many suggest the use of some kind of additional support like acellular dermal matrix.  If your current result is stable, I would advise to leave it. It is not perfect but still good.

John J. Corey, MD · Answer

I totally understand your concern because capsulorrhaphy is such a hard operation and there can be a long recovery. My advice would be get yourself a Victoria secret knock out bra and wear it 24/7 except to shower. I like those for capsulorrhaphy and if by six months it doesn’t move I think you will be close enough to be happy!!

Daniel Brown, MD, FACS · Answer

Sorry to see that you are having these issues.  Unfortunately it does appear that you are bottoming out again, though not nearly as severely as before with the left much more severe than the right (as previously). Your surgeon accomplished quite a lot of correction with the first revision, as you had severe bottoming out.  Your right looks quite nicely placed currently.   It does appear that at least your left breast will require further revision for the best result.  I would encourage you to wait a minimum of 6 months after your last revision to allow complete healing and settling before proceeding with another revision.  Best wishes!Daniel Brown, MD, FACSBoard Certified, American Board of Plastic SurgeryMember, American Society of Aesthetic Plastic SurgeonsMember American Society of  Plastic SurgeonsCastle Connolly Top DocReal Self Top 500

Bao L. Phan, MD · Answer

Based on the pics it does appear that your left breast had bottomed out a little again but it’s still much improved from before your revision surgery.  Your left breast looked significantly worse than your right breast pre- op so it’s not surprising that it did not hold up as well.  It’s really difficult to correct that much bottoming out with the capsulorrhaphy technique alone.I find the aftercare is also very important to help the repair heal adequately before stressing it again.  Usually I have my patients wear a snug underwire sportsbra for at least 6 months post op and have them refrain from high impact exercises.  Also if the implants are excessively large implants, I usually recommend that they be downsized as excessively large implants require more overdissection and place more stress on the IMF support, increasing the likelihood for bottoming out as well as recurrence of the original condition.  Best wishes.

After capsulorrhaphy am I bottoming out again? 2 months post op. (Photos)

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