The final appearance, shape, and movement are not exactly the same as normal breasts. The surgically enlarged breasts do not move in the same way as normal breasts. They tend to be firmer. The contours are usually somewhat different than normal breasts. In some patients these discrepancies may be rather noticeable. Although every effort is made to place the implants symmetrically, complete symmetry is rarely achieved. Immediately after surgery, the breasts are swollen and firmer. The final shape and size is approximated after 2 to 3 months, but up to one year may be required for the end result.
Hello Maggie and thank you for your question. It appears that both your implants are bottomed out: part of the odd shape you are noticing is that both of your nipple to fold distances are too long. You will need an in-person examination to decide if you will need the extra support of an acellular dermal matrix (like strattice) vs capsule work to reinforce your pocket (but you would probably have to wait 2 months out from your last surgery), versus a combination of the above and cutting out a wedge of excess skin below to shorten your nipple to fold distance (don't worry, the scar would be hidden in your inframammary crease). I hope this helps to answer your questions. Please make sure to seek consultation with a board certified plastic surgeon with expertise in revision breast surgery.
Dr. Sean Kelishadi
From your photos it seems that your implants have bottomed out; when this occurs early, it is usually due to release of the inframammary fold; You will require reinforcement of this fold and possibly a wedge excision of your lower breast skin to provide you more proportioned breasts.
From your series of photographs, it appears to me that the right breast has bottomed out.When a breast implant migrates below the original placement location with the bottom of the implant just above the infra-mammary crease, we call this “bottoming out.” There are several causes of this downward migration of the breast implant. Usually, some attempt had been made to lower the crease to accommodate a breast implant whose base diameter is larger than would otherwise fit in the natural breast. In doing so, the anatomic attachment of the skin of the breast to the chest wall can be obliterated. There is then nothing to hold the implant up. With the weight of the implant, and constant gravity, maybe lack of support by lack of wearing a bra continuously, the implant can settle downward. One of the earliest symptoms, I see in patients seeking revision,has been the feeling that the breast has to be constantly adjusted or just feels heavy. We look for the incision line, which was previously placed at the crease, to have migrated upward onto the breast. When we see this early on in the postoperative phase, it will never get better with time and will require a secondary repair. While some plastic surgeons may rely on suturing techniques only, I have found that unless we un-weight the implant by making it smaller or strengthen the tissues below by making them less stretchy, that the same implant, with just sutures placed on the bottom of the pocket, will, over time, recur it's bottomed out position. I have used part of the capsule as well as the lining of the deep muscles and tissues over the ribs in the capsule beneath the breast implants to rotate upward to hold the breast implant in a higher position and therefore obliterating the extra space that has been created between the correct infra-mammary crease and the one created by the downward displacement of the implant. I call this a three flap technique, as the skin, the capsule and fascia (lining of muscles), as well as a dermal flap all contribute to creating a hammock like support of the lower portion of the pocket. When these tissues are insufficient to hold the implant up, or a previous attempt has been made with sutures, I will oftentimes rely on the addition of another type of tissue called an acellular dermal matrix of which my preference is Strattice. This Strattice ,or pigskin, does not stretch and can be sewn in to the bottom of the new location of the crease to support it just like a hammock would. Although this is costly, I consider this an insurance policy against having to redo this again. I would recommend that you try and find a plastic surgeon with experience in revisionary cosmetic breast surgery. Good luck.
I would hold judgement on your implant placement until complete healing occurs which takes 6-8 months. It is important to wear a good support bra for these large implants. If after time, the implants bottom out, an acellular dermal matrix placed in the pocket or a skin flap could be used to provide support to the lower pole of the breasts.
and if you feel the implants are too low, you should be supporting them with underwire (yes, underwire that fits properly) to minimize the risk for further settling as its certainly possible it could happen. Once you are considered healed by your surgeon, you should have the opportunity to critique your results with your surgeon and pursue revision if felt to be beneficial.
The short answer is yes - your implants have bottomed out. They appear too large for your frame, which significantly contributes to the problem. Revising the implant placement and using a smaller implant (possibly with the addition of a small lift) will restore a more pleasing appearance to your breasts. Discuss your concerns with your surgeon and come up with a plan of action together.
Thank you for asking about your breast implant revision.
- Your nipples haven't moved upward - your implants are too low on the chest.
- And I agree with you - that your photo most recent photo show that the implant on the right in the photo is moving progressively lower on your chest. This is bottoming out.
- It may have been present from the start but that isn't clear from the photos.
- Release of the breast crease removes the lower support for the implant, and is a common reason for bottoming out.
- I suggest you return to your surgeon to discuss a surgical revision - and whether one or both implant pockets need revision.
Always see a Board
Certified Plastic Surgeon.
Best wishes - Elizabeth
Morgan MD PHD FACS