Are my implants bottoming out for a third time? 3 months ago, I had a bottoming out revision with Strattice. Help! (Photo)

This is my 4th augmentation. First surgery, I had subglandular BA. This was not ideal for me being that I had little breast tissue and was 18 years old. I had it redone under the muscle 5 months later. It bottomed out. Then we did a revision 6 months later. Bottomed out again. Three months ago, he did a revision again, added strattice. I still feel they are bottomed out. I want upper pole fullness. I am scared I will never get the look I want. Are they bottomed out or do I have a nice result?

Doctor Answers 10

Your implants are too big for your breast tissue

I am sorry that you had to have multiple surgeries and still did not get the result you wanted. Your implant are overstretching your breast tissue and can not get better than this. There is no breast tissue to cover your implants and your skin will stretch over time no matter what kind of support is used.  

New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

Bottoming out after augmentation

You have had 3 surgeries in a little over a year. That is a lot of surgery in a short period of time, so I would avoid more surgery for at least a year, if possible. Your implants look large for your small frame and may be contributing to your issues. 

Be sure your surgeon is board certified by the American Board of Plastic Surgery and has experience in revisional breast surgery.

Patricia A. McGuire, MD
Saint Louis Plastic Surgeon
4.4 out of 5 stars 8 reviews

Bottoming out

It does appear from the most recent pictures you have bottoming out. You will likely have responses that say you must decrease the size of your implants for success. I don't not think that is the case. There are many ways to treat this.  Success of the repair is correlated with the physicians experience. I would suggest you seek a second opinion in person with another plastic surgeon who performs several hundred breast augmentation and repairs per year. If a surgeon only does this repair 2-3 times per year his success will be likely less than if he performs closer to a hundred per year. Best of luck.

William J. Hedden, MD
Birmingham Plastic Surgeon
4.8 out of 5 stars 321 reviews

No bottoming out

I do not see bottoming out based upon your photos. Best of luck with your results. Good luck........

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Four breast operations but afraid of bottoming out

Thank you for asking about your breast augmentation.

  • Fortunately, I do not see evidence of bottoming out in the photos.
  • One would need to examine you and review your before photos to be sure.
  • Your breasts have had a lot of surgery - and the repeated past bottoming out probably reflects the size of your implants which look very large for your frame.
  • Large implants like naturally large breasts will make tissues stretch.
  • I think you have a nice result at this point - I would avoid further surgery if at all possible and if more is needed, please consider a smaller implant.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Bottoming out? Hard to tell

Hi.  From the pictures, it's difficult to see much bottoming out.  Large implants on a petite frame will tend to stretch out the tissues with time.  I think that tissue stretch is more of the issue here.  You may need to consider a vertical lift operation if you want even more superior fullness - but that comes at the expense of the scar.

Thomas Fiala, MD
Orlando Plastic Surgeon
4.9 out of 5 stars 80 reviews

May need skin removed

I'm going to have to agree with Dr. Salzman, it is difficult to tell from the photos if your implant has bottomed out. There does appear to be an excess of skin between your nipple and fold which can give the appearance of a malpositioned implant. If there is strattice in there already, your implant should be pretty well supported. You  may just need a wedge of skin excised from the bottom of the breast in order to put the nipple in a lower position. Discuss with your surgeon your options. Best of luck.

~Dr. Sieber

David A. Sieber, MD
Bay Area General Surgeon
5.0 out of 5 stars 34 reviews

Can't tell

From the look of your photographs, it appears that the left side has a distance from the bottom of the areola to the crease that is slightly longer than on the right. Without seeing your preoperative pictures, it's hard to tell if the right areola was lower than the left to begin with. If Strattice has already been placed, then the fix for that would be to take out a horizontal wedge of skin commensurate with the amount necessary to make those measurements from the bottom of the areola to the crease as close to the right side as possible. Upper pole fullness can also be created with fat grafting, especially when very large implants cause them to descend with gravity. Best of luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Bottoming out

It does not appear that you are bottomed out at all, I think you have a good result for what operation you had. It is physically impossible to put an implant higher on your chest, the implants are where they belong with the most projecting point of the implant behind the nipples.

Nathan Eberle, MD, DDS
Weston Physician
5.0 out of 5 stars 7 reviews

Difficult to say

This is very difficult to say from your pictures alone.  I would return to the revising surgeon and air your concerns. 

Ethan Philpott, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 17 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.