Bottoming out for a 3rd time in 16 months? Why won't my implants stay held up? 420cc unders inspira. A to 32DD (Photos)

Original ba was April 2015, 1st capsuloraphy was August 2015 and I had my 2nd capsuloraphy on March 30th 2016. Everything seemed fine, I kept a thong bra and push-up bra on for 9 weeks and still wear an underwire 24/7. Just recently I noticed my nipples hanging out of bras again. Why do my implants keep bottoming out ? My surgeon won't use a synthetic material like alloderm to help. I also have no cleavage in a push up bra and implants touch under the skin when pushed together

Doctor Answers 2

Internal bra for implant support after failed capsulorrhaphy

Since you have had 2 capsulorrhaphy procedures, it is clear that your own tissues are not up to the task of holding the implants up. This situation is an excellent use of an internal bra material such as Strattice or Galaflex. Unfortunately Strattice is quit expensive, and Galaflex is not available in Canada but there is a very similar product called Phasix.

Seattle Plastic Surgeon
4.9 out of 5 stars 54 reviews

Bottomed out implant

When a breast implant migrates below the original placement location with the bottom of the implant just above the infra-mammary crease, we call this “bottoming out.” There are several causes of this downward migration of the breast implant. Usually, some attempt had been made to lower the crease to accommodate a breast implant whose base diameter is larger than would otherwise fit in the natural breast. In doing so, the anatomic attachment of the skin of the breast to the chest wall can be obliterated. There is then nothing to hold the implant up. With the weight of the implant, and constant gravity, maybe lack of support by lack of wearing a bra continuously, the implant can settle downward. One of the earliest symptoms, I see in patients seeking revision,has been the feeling that the breast has to be constantly adjusted or just feels heavy. We look for the incision line, which was previously placed at the crease, to have migrated upward onto the breast. When we see this early on in the postoperative phase, it will never get better with time and will require a secondary repair. While some plastic surgeons may rely on suturing techniques only, I have found that unless we un-weight the implant by making it smaller or strengthen the tissues below by making them less stretchy, that the same implant, with  just sutures placed on the bottom of the pocket, will, over time, recur it's bottomed out position. I have used part of the capsule as well as the lining of the deep muscles and tissues over the ribs in the capsule beneath the breast implants to rotate upward to hold the breast implant in a higher position and therefore obliterating the extra space that has been created between the correct infra-mammary crease and the one created by the downward displacement of the implant. I call this a three flap technique, as the skin, the capsule and fascia (lining of muscles), as well as a dermal flap all contribute to creating a hammock like support of the lower portion of the pocket. When these tissues are insufficient to hold the implant up, or a previous attempt has been made with sutures, I will oftentimes rely on the addition of another type of tissue called an acellular dermal matrix of which my preference is Strattice. This Strattice ,or pigskin, does not stretch and can be sewn in to the bottom of the new location of the crease to support it just like a hammock would. Although this is costly, I consider this an insurance policy against having to redo this again. I would recommend that you try and find a plastic surgeon with experience in revisionary cosmetic breast surgery. Good luck.

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

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