Bottomed out in one, fold in another - to repair or replace?

I went to a preop appt today for new implants (same size, 325) and a repair due to one bottoming out and the other having a prominent fold. My surgeon changed his mind about suggesting new, improved implants for my size saying he didn't want to disrupt the good side despite the fold. I feel like I should make the most of having to go under so they can heal similarly. He wants me to think about risks, and to consider downsizing if I replace both which I don't want to do but it's up to me - help?!

Doctor Answers 4

About Breast Implants "Bottoming Out"

"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.

Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Breast Revison Surgery.

I would suggest operating on both sides based upon your description. That is the best chance of making you symmetrical.  If you open the pocket to put in a new implant then you have taken the risk of a complication. Ultimately you want to trust your PS so try to follow their logic - if it does not make sense to you then you need to get another opinion.

Robert Kearney, MD, FACS
La Jolla Plastic Surgeon
5.0 out of 5 stars 32 reviews

Bottomed out in one, fold in another - to repair or replace?

Generally speaking, I advise patients who are about to undergo revision surgery to "fix" whatever concerns there may be (as much as possible, safely)  during the time of the revisionary surgery. In your case, if you have significant concerns about breast shape  and/or breast implant positioning, this may be the best time to address your concerns. Of course, making the decision whether or not to proceed with this type of surgery should be made after careful consideration of pros/cons/risks/complications associated with the revision surgery.  You may find attached link, dedicated to revisionary breast surgery concerns helpful to you as you learn more. You may also find it more helpful if you choose to post photographs with your next question. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Breast revision surgery, to replace implants or not?

Hi Sunny,

Thanks for your question. Photos would certainly help in your assessment. Also a bit more information would also help in how old are your implants. If you have a double bubble or two folds on one side, then I would definitely correct that at the same time as fixing the bottomed out breast. Both of these can be done at the same time while upsizing. It is something that is routine done with a capsule work, or the scar tissue around your implants. I would reinforce both breast to make sure they settle evenly but that certainly takes more work and cost typically increase. The best person to answer this question is your surgeon. You can always meet with other board certified plastic surgeons to get another opinion, as these best recommendations come from an in person examination and consultation! Good Luck!

All the best,
Carlos Mata MD, MBA, FACS
@revisionbreastsurgery @breastaugmentation @docmata #drcarlosmata
Board Certified Plastic Surgeon

Carlos Mata, MD, MBA, FACS
Scottsdale Plastic Surgeon
5.0 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.