If I have a breast revision, how can bottoming out breasts be prevented? (Photo)

Your breasts are wider than your chest wall which leads to mechanical instability. The only thing holding up your implants is the skin envelope and the breasts will continue to bottom out. You need smaller implants, the pockets need to be reinforced inferiorly and laterally and dissected more centrally and upward to allow the implants to sit higher. At the same time, you will most likely need the areolas displaced more medial and elevated as well. Mesh is usually not effective as it will be absorbed.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question. A large portion of my practice is dedicated to breast surgery and revision breast surgery. I have been in practice for over 28 years. In your case, you would benefit from an internal bra procedure - capsulorrhaphy. I wrote the very first paper on capsulorrhaphy over 20 years ago. I find that many surgeons are not skilled at this procedure and have high rate of recurrence. You should be able to have an excellent result. Best wishes to you

Dear snw54568,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Implants bottom out because of stretching your tissue thinly and not having enough support to hold them in place. You need to go smaller and may need mesh for good support. Please do not go larger.

To correct bottoming out an internal bra with a long term absorbable mesh, combined with infra mammary fold correction usually works well

Dear snw,
The glaring question here is; why do you have such a long scar on your left (bottomed out) breast? Were there different procedures performed on each breast? The full story might impact the responses you receive here.

To make an assessment on the outcome of a plastic surgery procedure, we generally like to see a complete set of proper before and after pictures.
There are generally three variables that determine quality breast augmentation outcomes.
The first is the patient candidate for the procedure. The second is the choice of implants in regards to size shape, and type. The third variable is the surgeons ability to place the implant in the correct anatomic location.
Variables such as nipple position cannot be changed by the surgeon.
Patients candidacy for the procedure include variables, like breast position and nipple divergence.
Nipple divergence can be amplified by augmentation as the implant creates projection in the direction of the nipple.
This cannot be corrected by placement of the implant.
Bottoming out happens when the pocket supporting the implant is not done correctly with violation of the infra mammary fold.
Correcting bottomed out implants is fairly complex and patience. Should be aware that not all plastic surgeons have experienced doing this repair well.
It’s typically done with a combination of internal sutures with or without Suport using either mesh or cadaver dermal products.
All alternatives have certain advantages and disadvantages.
The number one variable is the providers, skill and experience.
When selecting a provider for this type of a procedure, ask providers to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had the same procedure or correction for the same problem.
For those seeking primary augmentation, I suggest patients start the process by having multiple in person consultations.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who have similar body characteristics to your own.
An experience provider should have no difficulty showing you before and after pictures of at least 50 previous patients.
Being shown a handful of pre-selected images, representing the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like, or how many of these procedures they’ve actually done.
Highly experienced provider should have access to 100s or preferably thousands of before and after pictures.
Ask each provider what their most common reason for revision surgery is, what their revision rate is and what their revision policy is.
There’s no correct number of consultations needed to find the best provider.
The more consultations you scheduled the more likely you are to find the better provider.
The biggest mistake patients make a scheduling only one consultation, and then scheduling surgery.
This pretty much eliminates the ability to choose the better provider.
I do not think you can find the right provider without having in person consultations properly betting providers like you were hiring someone to do a job for you which is what you are doing.
I generally recommend against virtual consultations when possible, and generally do not recommend people travel long distances for elective surgical procedures.
Correcting bottom out implants needs to be done correctly or the condition will recur.
There isn’t much surgeons can do about your nipple position, and this should be accepted and explained during the initial consultation.
What the surgeon does have control over is placing the implant in the correct anatomic location and making sure there is sufficient tissue secure, and support the implant.
Best,
Mats Hagstrom, MD