What is the true reason behind bottoming out implants?

Lack of adherence of the implant. This may be due to:-poorly adherent implants: smooth shells or microtextured (the top are the macrotextured and the nº1 the polyurethane coated ones which make a real bio-velcro)-unadequate and insufficient postoperative immobility: must be at least 3-4 weeks staying quiet at home and off work-any accidental or uncommon issue: bleeding, milking, etcIn my experience as regular revision surgeon I can tell you that the leading cause is the use of outdated implants with smooth or microtextured shells, followed closely by patients whose doctors dis not emphasize or prescripe the suitable and strict postp immobility... or the patiens literally passed by.Your deformities when you contract the muscle should be seen in pics, they sound like suboptimal execution of a submuscular placement technique.To clear out doubts: bottom out, conceptually, can't even be attributed to surgeon's fault overdissecting the pocket... thay issue may happen but is called malposition, when bottom out is a progressive dislocation of implants sliding downwards and does not happen suddenly, it is an increasing deformity which appears months or even years after the primary surgical procedure.

The animation deformity you are describing comes from inadequate release of the muscle.  If the bottoming out is from a technical error, it is from lowering the fold too much, which would be inconsistent with the inadequate release of the muscle. If you have both, it is probably because the tissues are too weak to support the implant and the weight of the device has stretched out the lower pole.  Revision operations performed by skilled and experienced surgeons are quite successful.  Every operation does not diminish the breast tissue.  You need to find a specialist in your area that you can speak to to have your issues addressed in a way that can clear up misunderstandings about your condition.

Thank you for the question.  Although frustrating, breast implant malpositions  are not necessarily the fault of the surgeon. Sometimes, the complication may occur because of “over dissection"  or poor surgical judgment;  sometimes, it results because of patient tissue quality/time/aging/changes with pregnancy/genetics/muscle contraction…Generally speaking, one of the most common complications after breast augmentation surgery is implant malposition. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. This is corrected by “raising” the inframammary fold using internal sutures ( capsulorraphy). Sometimes, depending on the situation, patients benefit from the use of additional support materials such as acellular dermal matrix or biosynthetic mesh.  I hope this,  and the attached link (dedicated to breast augmentation revisionary surgery concerns) helps.  On the same website ( under the page labeled “case of the week”) you will find many examples of revisionary surgery done for breast implants that are bottoming out. Best wishes.

Dear Jewls Sims,

Thank
you for your clinical post. Post-breast
augmentation side effects and complications are relatively uncommon, but when
they occur are very stressful. Bottoming
out can occur from a multitude of factors – the size of the implant and weight
of the implant relative to the collagen content of the skin and the adherence
of your skin to the soft tissue of the chest wall. In general, I have always made it a point to
recreate the inframammary crease and fix that crease to the chest wall. Usually this is very successful in forming an
autogenous or biological under-the-breast support system. This technique, however, comes with minor and
rare complications of its own, but on the balance of probabilities, over time,
heavy implants in a slight chest wall with lax skin will generally tend to
bottom out over time. This bottoming out
is a natural phenomenon of Isaac Newton and weight overcoming the tensile
strength of the soft tissue supporting it.


Although
no pictures are provided to confirm your dynamic abnormality when you contract
your pec muscles, a subpectoral placement with release of the lower third of
the pec major muscle will still result in some degree of lateral migration of
the breast when contracting the pectoralis major. This is one of the well-documented side
effects of putting an implant in a dual plane or subpectoral position. Usually the plastic surgeon will discuss this
with you preoperatively, but it is usually a good tradeoff versus going above
the muscle and subcutaneously. Even with
cohesive gel implants, there tends to be a rather unnatural upper pole
appearance with a sharp takeoff of the implant-chest junction.

All
of these issues will be very concerning to you and some can be corrected, such
as the bottoming out, with inframammary fold revision surgery. This is simply performed under local
anaesthetic without actually having to expose the implant and usually without
having to do any kind of pocket dissection.
If there is a significant amount of migration or contraction of your
pectoralis major, a slight release of the inner lower part of the pec major may
be necessary to minimize abnormal breast implant migration upon contraction of
the pec major muscle.

Overall,
you are probably very happy you have performed the best augment surgery an
sometimes minor revision surgery is required.
Enhancement surgery is very common with breast implant surgery. I would seek the advice of your original
plastic surgeon, as they are in the best position to make the most informed
decision about the operative techniques that were performed. If you have lost confidence in that
patient-physician relationship, you may seek out the advice of other plastic
surgeons with significant primary and secondary breast procedures.

For
more information, please review the link below.

I
hope this information has been of some assistance and I’m sure you will get an
excellent long-term result that you’ll be happy with.

Sincerely,

R.
Stephen Mulholland, M.D.

Certified
Plastic Surgeon

Yorkville,
Toronto

Bottoming out can occur due to weak or thin skin that stretches due to the weight of the implant. It also can occur when the pocket is dissected too low.Double bubble, bottoming out of the implant when you can see an indentation above the bottom of the implant which creates the appearance of double bubble, indicates that during surgery dissection was carried too low and the inframmary crease (the fold under the breast) was violated and cut through.Either of the conditions can be successfully corrected without damage to or loss of breast tissue. See article below: