Bottoming out. Can someone see or understand what's happened?

Question

Pictures 1st 3wks, 2nd- 6, 3rd - 11, 4th-13, 5th-7months. Im bottoming out, i’m going to see my surgeon for a revision next week, from the beginning i’m been saying they don’t look/feel right. Can someone see or understand what’s happened? they have always been a diamond shape. reduction uplift and 375cc implants over the muscle - surgeon = GMC/DM/FRCS/E.B.O.P.R.A.S. (UK)

Gary M. Horndeski, MD · Answer

You had an inadequate breast lift. The additional weight of the implants is causing your breasts to descend even more. At this time, I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Fearless590719,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Brian Bassiri-Tehrani, MD · Answer

You are correct - the implants you have in place unfortunately have bottomed out and appear to be lower than your natural breast crease (or infra-mammary fold/IMF). This can happen for several reasons. One reason can be from having very large implants and poor support internally/skin quality - often times it is a combination of both. A revision surgery would be needed to correct this deformity, and depending on your goals, you may be a candidate for an "internal bra" where a mesh is placed around the breast implant and secured to your chest wall to give extra support to prevent the implants from bottoming out again. The need for mesh may depend on the size of implants you wish to have replaced, if any at all. The bigger the implant, the higher the risk of bottoming out and need for support with a mesh. These meshes are off-label but have been safely been used in cosmetic and reconstructive breast surgery routinely, and is well accepted. Hope this helps and hope all goes well with your revision surgery next week!

Connie Hiers, MD, FACS · Answer

Your implants are too heavy for your tissue and are not being supported by anything but your breast. They are sagging down from the weight. I suggest you go smaller and place the implants behind the muscle. Then the bottom area can be tightened and reshaped.

Bottoming out. Can someone see or understand what's happened?

Answers (4)

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