Can someone tell me what’s happened? Am I bottoming out?

Question

i had a reduction, lift and implants in january 2023. I’ve had 3 children and was left with empty 34D. My surgeon suggested 375cc in both breast with reduction and implants. i wanted a fuller upper pole as it was very deflated. i went with high profile. since the beginning i’ve been concerned but my surgeon and nurses said they would round in time but i’m over 7month and i think they are just getting worse.

Wayne I. Yamahata, MD · Answer

Your photo suggests that the aesthetic appearance could be improved by shortening the distance between your nipples and the inframammary folds and possibly raising the positions of the implants. Ask your surgeon if one or both of these would be of reasonable benefit.

Steven Sigalove, MD FACS · Answer

First of all, those breasts are never going to round out on their own. Your inframammary folds appear stable based on this photograph. However, it appears that you have an elongated and stretched out lower pole giving you an extremely long nipple to fold distance. This is a common finding when only a circumvertical mastopexy is performed without using an inverted T incision. Without examining you, I cannot tell if you have capsular contracture which could also be causing the distortion in your lower poles. You definitely need a revision with a full inverted T mastopexy where all of that stretched out and elongated lower pole skin can be resected giving you a tight and crisp inframammary fold and lower pole.

Fernando Ovalle Jr., MD · Answer

Hello and thank you for your question! I understand that it is frustrating to not see the results you were looking for. From the appearance of the photos it appears the breast implants have "bottomed out" and have stretched the lower pole of the breast with loss of the strength of the IMF (inframammary fold). In my opinion, this will not improve on its own and would require a revision surgery to perform a revision mastopexy-augmentation with resetting the IMF and reinforcing the lower pole tissues with products like galaflex (biosynthetic mesh) or ADM (acellular dermal matrix).

Vishnu Rumalla, MD · Answer

Thanks for your inquiry,  I suggest you discuss with your surgeon about shortening your nipple to fold distance and consider using some absorbable mesh like Galaflex to hold it in position.

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

Miguel Mota, MD · Answer

Hi. Sorry to hear you are not happy with your procedure. It seems to me that you either had a very low breast fold to begin with, or you are bottoming out. Unfortunately, you need a revision. I feel slightly smaller implants plus a breast lift with breast fold reconstruction will fix your issues. Breast fold reconstruction alone will leave you with excess skin and might even lower your nipples…. This is why another lift is necessary for optimal results.

Best of luck,
Dr. Miguel Mota

Best of luck,
Dr. Miguel Mota

Zoran Potparic, MD · Answer

This is, unfortunately not so rare complication after breast lift and relatively large implants. Due to gravity, stretched, thin skin and breast envelope, implants have dropped down, stretching the lower pole of the breast and pushing breast crease (inframammary fold, IMF) down. One of the ways to correct this is to stabilize IMF by attaching the flap of tissue, sometimes reinforced with synthetic mesh, to the chest wall in higher position. This will  lift implant into position where it was immediately after surgery and expand the upper breast pole.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photograph. Yes your implants have bottomed out and you will require a surgical revision, likely with the addition of mesh to improve upon your current results.  Seek out a series of consultations to get the best treatment advice after an in-person examination.

Elizabeth A. Killion, MD · Answer

Hi fearless, 
Yes you are bottoming out. Your skin and breast tissue is now no longer supporting your implant. I would recommend a revision likely going down in size of your implants and using a mesh to support the lower portion of your implant so that it is less likely to drop again. Good luck!

Connie Hiers, MD, FACS · Answer

You are bottoming out from the weight of your implants. They can be raised again and use mesh for an internal bra to give support. You may need to go down in size so the implants are not as heavy on your tissue.

Can someone tell me what’s happened? Am I bottoming out?

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