What is the Best Operation to Fix my Bottomed out Breast Implants & Symastia? (photo)

2 years ago I got silicone implants &6 months later a lift..had capsular contracture which was corrected in the lift surgery, but still see awful indentions, symastia & odd-shaped breasts,& my areolas are getting bigger (initially huge, reduced in the lift)+they're sagging again..surgeon was board certified but I'm scared to go back bc I don't know if any of this is his fault-also had some stitches pop out of my skin ~4mos. after the lift (fixed now). Based on my pics, what are your suggestions?

Doctor Answers 8

About Symmastia & "Bottoming Out"

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#Symmastia is a condition which can occur when the implants are too close together. Patients often refer to this as a “uniboob.” Occasionally, the space or pocket for the breast implant is created towards the center, or the tissue stretches, forcing  the implants to fall too much towards the center of the breasts.  Currently, you do not appear to have #symmastia.

"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. 

Correcting such issues is based on personal choice. Additional elective cosmetic #surgery is a personal choice. Your procedures should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for a revision surgery. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

What is the Best Operation to Fix my Bottomed out Breast Implants & Symastia?

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Thanks for the posted photos. You have many post and pre surgery issues that over the internet are to difficult to address in any detail. Best to seek a few in person opinions from boarded PSSx in your area. Good luck and sorry for your experience. 

Difficult breast surgery revision

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I think you need to consider a neopocket approach.  This is a complex procedure and should be discussed thoroughly with your surgeon.

David A. Lickstein, MD
Palm Beach Gardens Plastic Surgeon
5.0 out of 5 stars 9 reviews

Revisionary Breast Augmentation Surgery Options?

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Thank you for the question and pictures.

Although it is not possible to give you precise advise without direct examination and a full communication of your concerns and goals, I think you will benefit from revisionary breast augmentation surgery. Based on your pictures, I think you do have some degree of breast implants malposition ( inferiorly and medially),  which can be improved upon with manipulation of the breast implant pockets. This operation using internal sutures ( capsulorrhaphy)  will serve to improve the breast implant position in relation to the breast tissue.  Improve symmetry of the breasts and improved positioning of the nipple/areola complexes on the breast mound may also be achieved.

I would suggest that you meet with well experienced board-certified plastic surgeons who can demonstrate significant experience with similar breast revisionary surgery.

Best wishes.

Revision breast surgery

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Whenever a patient is unhappy with their result revisional surgery may be an option. The causes of the unhappiness need to be accurately described by the patient and the patient also needs to define what they want as their final result. Th Dr can the assess what the anatomic problems are and offer options. Important i all of this is where the patient started from. Very often revisional surgery is better named "refinement" surgery because the patients result is better than how they started but they want an even better result f that is possible.

Your best bet at this point is to take all your records and see a board certified plastic surgeon with an expertise in breast surgery and have a second opinion consultation. It will be money well spent.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 37 reviews

Fixing bottomed out breast implants

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Based on the photos you submitted, my interpretation of your status is different than you suggested.  I don't see any evidence of symmastia nor do I think your implants have really "bottomed out".  I believe the root of your problem is that your implants are too big.  The weight of the implants will cause the skin to stretch and cause recurrent sagging.  Generally, if you need a lift, I recommend that the implant size be limited to avoid this problem.  You have already demonstrated that your skin has lost elasticity and will not be able to support such a big implant.

Jeffrey E. Kyllo, MD
Seattle Plastic Surgeon
4.7 out of 5 stars 13 reviews

Breast Augmentation revision, what can be done?

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I would tell you to go to a reputable PS who is board certified and enjoys and performs breast augmentation revisions. He will need your records and then will be able to give you an honest opinion and hopefully help. Good luck, and if in doubt seek a second opinion.

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 93 reviews

Breast revision

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Sounds like you need to be examined very carefully, to review your history and then offer a plan for improvement. Remember revision surgery can often make the breasts look closer to the same but never identical.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 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.