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

Question

I have a bottomed out breast, uneven nipples, nipples that sit high on the breast, and one breast that is more lateral than the other. If I were to have a revision, what would be the best way to prevent this from happening again? Is it best to use internal sutures or strattice? What are the cons of both methods? My original PS advised against internal bra using mesh.

Gary M. Horndeski, MD · Answer

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.

Paul E. Chasan, MD, FACS · Answer

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

Daniel Barrett, MD · Answer

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

Connie Hiers, MD, FACS · Answer

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.

Hilton Becker, MD · Answer

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

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

Answers (7)

Answer: Implants

Answer: Implants

Answer: How can bottoming out breasts be prevented?

Answer: How can bottoming out breasts be prevented?

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Everything you need to know about Breast Implant Revision

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

Answers (7)

Answer: Implants

Answer: Implants

Answer: How can bottoming out breasts be prevented?

Answer: How can bottoming out breasts be prevented?

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Recommended reading

Everything you need to know about Breast Implant Revision

Our mission is to create a world where every investment in modern beauty is Worth It.