Bottomed out? 6 month PO. (photos)

saved for this surgery it took all I had!! 106 lbs and 5'4. I have 375cc high profile silicone implants with incision on folds ( suppose to be). My nipples seem to high and my incisions are high and way to visible. If I havet to have surgery again will I havet to pay ? Also will it cause my scars to be even more so visible. And will the soreness be just as bad? Please help

Doctor Answers 5

Bottomed out? 6 month PO.

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I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”).

It is possible that you are feeling the implants significantly along the lower poles of the breasts. Patients in your situation often complain of discomfort in the area of implant malposition. 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 benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). Sometimes, depending mainly on the patient's history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh. 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 (dedicated to corrective surgery for bottoming out concerns), helps.

About "Bottoming Out" and Managing Scars

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"Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.
Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant.
This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold.

To manage scars following the procedure, I suggest #scar maturation products to my clients. Such as BioCorneum or Embrace, to name a few, are recommended. But, it's best you wait a few weeks following your surgery, to begin using them and speak to your surgeon about healing concerns.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Bottomed Out- Straight Forward Solution

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Hello Casey,

This is a problem seen occasionally.  The solution is to reinforce or hem up the capsule from the inside and replace the implants in that pocket.  This is called a capsulorrhaphy.  The scar is in the same place.  The pain is different- usually a pinching type of pain.  It is different than the first surgery.  I ask my patients to wear their bra almost all the time for several months afterward.  I would discus revision with your original surgeon.  He or she may give you a fee reduction.  I hope all goes well.

D`Arcy Honeycutt, MD
Bismarck Plastic Surgeon
4.7 out of 5 stars 24 reviews

Implant malposition

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You are correct that your implants have settled lower and as a result makes you nipples higher on your breasts. The correction will involve repairing the internal capsule to support the implants and get the scar back into the inframammary fold. I recommend discussing your concerns with your plastic surgeon to develop a plan. It is best to wait at least 6 months to allow some capsule to form to be able to repair.

I hope this helps

Dr. Edwards

Implant Bottoming Out

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It seems your implants have moved a bit too low and the incisions have rolled up, which are possible signs of bottoming out. An in-person exam is of course needed along with review of your before and after photos from surgery. Repair of the condition is often straightforward and usually involves less downtime and discomfort than the original procedure.  Your surgeon may have a policy that will outline what fees you would be responsible for in case of revision.

John LoMonaco, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 276 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.