I have no cleavage and nipples hanging out of bras and bathing suits. Is my implants bottoming out? What to do next? (photo)

Question

I had a BA on April 29th 2015 - 420cc Natrelle Inspira SSX under.I noticed right after the surgery that one breast seemed lower+ had a sag to it and just got worse and worse. July 10th I had a surgery to move my nipple down (they were uneven before surgery) + the breast still looks lower. The incision is way higher than the other.I found that both my nipples were constantly hanging out of bras. Seems to be a lot of fullness in the lower half and not the upper, making my nipples high

Richard J. Restifo, MD · Answer

Based upon your pictures and the story you tell about the nipples peeking out seems like a case of "bottoming", i.e. the implants are somewhat too low relative to the nipples.  Fortunately, this can be corrected by suturing the pocket capsule at the lower crease, but this will require more surgery.   It can be fixed "from the inside" through the incision that you already have. There is no rush to correct this situation and it may make sense to wait a few months until the settling has completed and the tissues have healed and firmed up. You should discuss these options with your plastic surgeon.  Best wishes.

Jonathan Saunders, MD · Answer

I wish I could see your preop pictures. I am wondering if you had the same preoperative asymmetry.? did one breast com eoff the chest wall higher than the other one did?

Jeffrey A. Sweat, MD · Answer

Believe it or not, studies have actually been done to determine the aesthetically "perfect' breast and by the standards judged by experts for a natural and aesthetic breast, there should be more fullness in the lower part of the breast than the upper part and the nipple should point very mildly upward.  In that regard, you have very aesthetically pleasing breasts right now.  However, most women who undergo augmentation want more upper pole fullness rather than lower pole, which is what you are lacking.  Additionally, augmentation patients generally want cleavage as well.  Cleavage cannot be produced by an augmentation due to the varying width of the breast bone and size of implants and should really be achieved with a supportive bra.  As far as upper pole fullness, this is a very unnatural, yet sought after, breast shape.  I would say that your surgeon has done a great job, but if you want more superior fullness and less problems with nipples showing through the bra, then raising the implants would be the solution, though can be at times unsuccessful.  Best of luck and I truly hope you achieve the results you seek!  Have an honest conversation what your plastic surgeon about what you are looking for and hopefully you can both agree to a solution.

Jed H. Horowitz, MD, FACS · Answer

You are still pretty early postoperative and it is difficult to comment on the results without seeing preoperative pictures. I would give yourself a little more time to heal and continue to follow-up with your plastic surgeon. Sometimes if you have a lot of preoperative asymmetry this is not corrected with an implant. You do have some bottoming out of your implant on your last pictures. However, I would recommend waiting a few more months before you consider revision surgery. #BreastAugmentation #PlasticSurgery #Recovery #Healing

Nelson Castillo, MD · Answer

Thank you for your photographs and questions.  Though I can see what you are describing in your narrative, it is difficult to really tell if your implants have bottomed out.  As far as the incision on your left breast, it appears that it was a little bit higher right after surgery, but it was the nipple lowering operation that seems to have stretched the skin of your lower breast causing the incision to climb higher.  I would voice your concerns with your plastic surgeon and have them examine your breasts to make sure they are sitting appropriately on your chest and not having dropped too low.

Steven Wallach, MD · Answer

I think that you need to post preop photos as well. It sounds like some bottoming out. Perhaps the implants were too big for your frame?

Peter E. Johnson, MD · Answer

Implants are bottomed out when the point of projection is below the nipple, and based on your photo alone your implants are low. The projection of the implant below the nipple causes it to appear too high or "looking upward" and the nipple above the bra is not an uncommon problem. There are solutions which might mean a repair of the capsule to support the implant and center it on the natural nipple position, and sometimes a different implant style, size, or shape can solve the situation. See your surgeon for help.

Tom J. Pousti, MD · Answer

I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are understandable; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”). Also,  consistent with the breast implant positioning problem, the nipple areola complexes seem to be sitting relatively high, because the breast implants have settled too low. 
I think you will likely benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair).  This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly.  Associated issues with positioning of nipple/areola complexes   should improve with this operation.
Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery. 
I hope this, and the attached link, helps. Best wishes.

R. Stephen Mulholland, MD (retired) · Answer

Dear chrisxo,

Thank you for your clinical post and photographs.  I’m sorry to hear of your early post-op wound
healing issues and concerns.  From the
photos posted it does appear as if there is some bottoming out and more
fullness in the lower pole of the breast implant and breast mound.  You are still quite early since your primary
surgery and a visit with your breast surgeon and the little tincture of time
for 3-4 months to allow the soft tissues to settle may be the best initial
advice.  It is difficult to operate in
acutely inflamed surgical field and the operative tissues need to settle.  Once they have settled bottoming out as a
primary cause for the nipple-areolar complex riding high will become apparent
at this time it will be much easier for your breast augment surgeon to
restructure the inframammary fold, open up the upper pole of the pocket and
move the implant superiorly with support sutures by using the recently formed
capsule and fixing the inframammary fold incision to the rib cage.  Now is not the time to perform this
surgery.  Now is the time to allow the
implants and soft tissue to settle even though the aesthetic result is not
optimal.  Additional capsular tightening
on the lateral aspect of breast at the time of your enhancement surgery and
opening up the medial pocket will allow modest improvement in the cleavage.

I would seek the advice of your operative breast surgeon and
patiently wait until they deem intervention to be appropriate which is usually
6 months after the last surgery.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

I have no cleavage and nipples hanging out of bras and bathing suits. Is my implants bottoming out? What to do next? (photo)

Answers (9)

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