Are my breast implants too low? (Photo)

Question

I asked for high profile implants with lots of cleavage at the top. But I feel they have been placed too low and I have not at all achieved the upper cleavage look I desired. They seem to make my torso look short and if you compare to my natural breasts are much lower (look at the freckle on my sternum). Is this bottoming out or were they originally placed too low? my nipples also point upwards.

Carlos Marciales, MD · Answer

Hello, thank you for asking, yes, apparently your implants are very low, more than 60% of the implant is below the nipple, you probably need a revision.

Brian K. Reedy, MD · Answer

Thanks for your question! I'm not sure placement of the implant is the issue. I think you chose too large of an implant for your breasts. Because you have natural pseudoptosis, I would've encouraged a smaller implant to start. You could've always replaced to go bigger. I think smaller implants are the right answer and a revision is probably necessary. Good luck!

Daniel Barrett, MD · Answer

Dear honeybellex,
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

Ira H. Rex III, MD · Answer

Your right at that your nipples should not be pointing up. You have to speak about these concerns with your plastic surgeon. A revision May certainly be considered, but your surgeon may want to wait a certain amount of time before moving the implants into a better position.

Gene Sloan, MD · Answer

You don't say how long postop you are, but judging by the scars, a few months.  If they were in that position immediately after surgery, then they were placed too low. More likely, they were much higher right after surgery and migrated down, so they have bottomed out, also known as inferior malposition.  With an implant that size on your frame with an ill defined pre-existing inframammary crease, bottoming out is a fairly predictable event. A number of things can be done during the post-op period to try to prevent bottoming out.  But none are 100% effective. An implant that size on your frame under the muscle has a lot of downward force with pretty thin tissue at the bottom of the breast trying to resist that force.  As the lower pole skin stretches, it gets thinner and weaker and stretches more. Fortunately the problem can be corrected with an inferior capsulorrhaphy performed through the existing scar. Your surgeon should be very capable of doing that. It is something we all see from time to time.

Karl William Schwarz, MD · Answer

Your implants have bottomed out and when they do they make the nipple position higher and therefore make your nipples point upwards (stargazer nipples). When the implants bottom out it also increases the distance from the nipple to the fold and gives the breast an unusual appearance.

It is a common misconception that a high profile will increase the volume at the top of the breast. That's actually not what happens. The high profile gives the breast more projection, not more fullness on the top. To get more fullness on the top and more cleavage in the higher aspect of the breast the implant needs to be in the correct position. Right now your implant is not centered under your breast but it is centered much lower. To get more upper cleavage the implant position would have to be changed, in other words the bottoming out has to be corrected.

Connie Hiers, MD, FACS · Answer

Your implants are too large and heavy for your tissue and are bottoming out. Go back to your surgeon and discuss your options. the best option would be for mesh support and smaller implants.

Camille Cash, MD · Answer

Your implants are bottoming out.  This can sometimes happen with larger implants, thin tissue, or a combination.  Surgical intervention is needed to correct this.  To lower your risk of this happening again you can consider smaller implants  or perhaps add mesh.

Mats Hagstrom, MD (license on probation) · Answer

Breast augmentation outcomes are based on three variables.
The first is patient candidacy. The second is implant selection and the third is the surgeons ability to put the implant in the correct anatomic location.
In your case it’s the second and third variable that are causing problems.
You were a very good candidate for breast augmentation to start with.
Your breast have fairly ideal placement on your chest wall, and you didn’t have much divergence or other issues.
Most likely, the problem started with implant selection.
When you choose implants that are larger than the natural diameter of the breast, the implants have to go somewhere.
 in order to make the implants fit your surgeon most likely opened the IMF or infra mammary fold.
The IMF is an important anatomic structure that needs to be maintained in order to not let the implant slip down due to gravity and contractual forces of the pectoralis muscle.
It’s easy to keep the IMF intact when using appropriate sized implants.
Your implants have bottomed out and the reason for this is due to technical error, which in part is directly related to choosing such large implants.Correcting bottomed out implants is difficult.
The chance of success goes up if you find surgeons who have experienced treating this complication.
Closing the pocket and restoring the IMF is usually done with permanent sutures that is often reinforced either using mesh or cadaver dermal products like Alloderm. 
Downsizing your implants in conjunction will increase the chance of success.
Implant envy is a very real thing.
Whenever patients choose excessively large implants that are far larger than the natural breast diameter, they increase the chance of undesirable side effects, higher complication rates, and definitely increase the need for revision surgery.
Correcting this deformity is not easy.
You need to find a plastic surgeon who has proven crack, record, correcting bottomed out implants.
That may take some looking around.
I suggest scheduling multiple in person consultations with plastic surgeons in your community who seemed to have a lot of breast surgery experience.
Consider consulting with plastic surgeons who do most of the breast cancer reconstruction in your community.
 Surgeons who do a lot of breast cancer reconstruction surgery tend to be good at complicated breast surgery.
The hands of an inexperienced doctor, correcting bottomed out implants can easily fail or cause deformities.
It’s not an easy operation.
When consulting with providers, ask them how many cases like this they’ve done in the past and asked them to open up their portfolio and show you their entire collection of before and after pictures of previous cases with similar outcomes.
You should also ask them what their revision rate is for correcting this deformity.
If you opt to maintain the large implants, the chance of success goes down significantly.
As I mentioned earlier breast, augmentation outcomes are based on three variables.
The first is patient candidacy the second is implant choice and the third is the surgeons ability to put the implant in the correct anatomic location.
As I mentioned earlier in your case, it is implants selection and surgeon’s anatomic placement of the implants that caused the problem.
Whenever patients are unhappy with breast augmentation outcomes, we can almost always derive the problem as being related to one or more of the three above stated variables.
In the hands of the right provider, you should be able to get a stellar outcome.
As I mentioned earlier correcting this deformity is not easy or straightforward so start your search for the right surgeon to help you out.
Best,
Mats Hagstrom MD

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