Am I bottoming out? Breasts falling below incision line. (photos)

Question

My breasts don't seam to fold over the incision line as I was told they would. They fall just below it, especially my left breast. I did not have much to start with and got 300cc moderate profile under the muscle 1st dec 2016. My next appointment is in April but should I be concerned and make an appointment sooner? Thanks for your help!

Alejandro Nogueira, MD · Answer

Sometimes the implants fail to form strong fixation to the ribcage, and may displace their location downwards due to gravity, this is so called bottoming out; factors to develop bottoming out are:-using non-5th generation implants, this is smooth or microtextured implants with poor adhesion to tissues-even with the best implants (macrotextured), when the patient does not keep strictly 4 weeks of total, absolute and obsessive immobility, closed at home, with idle arms and leaving work, chores and dutiesThe process is unstoppable and will stabilize when reaching a point of balance with the skin resistance (variable from patient to patient).Solutions:-raising the exceeded submammary fold by reattaching it to the ribcage with a multipoint capsulorrhapy-if you wish to prevent a new bottoming out, do this time behave in the postop as depicted formerly-may you wish additional certainty of no recurrence you may go for polyurethane coated implants, they are the leading ones in terms of fixation and adherence, they form a bio velcro and they are indicated in such cases of poor adhesionNotwithstanding, your bottoming out grade is slight, is a minimal descent, not a clear indication of correction; anyhow if you wished to undergo revison surgery it would be acceptable and reasonable, then seek the opinion of an expert in the aforementioned technique and model of implants.

Jerome Edelstein, MD · Answer

Hello,Thank you for your question and photos. Based on the pictures, you do appear to have some malposition/bottoming out of the implants. I recommend that you be seen in person so that your Plastic Surgeon can assess and talk about options.

Nicholas Jones, MD, FACS · Answer

Thank you for your excellent question and your photos.  You do have some bottoming out. The inframammary approach is the most common way to place breast implants. 
Planning the incision involves many factors including: the size of the implant, the location of your native fold, whether the fold will have to be adjusted, skin quality and stretch, as well as your nipple location. Over time, there will be some skin stretch which will cause the incisional scar to migrate superiorly.  In some cases the fold has to be adjusted, if the fold is not appropriately resuspended, the implant may migrate inferiorly.  
If there is a significant amount of bottoming out, you may need revisional surgery which may require the use of a mesh or dermal matrices to resuspend and stabilze the fold.  In some cases, this may also require exchanging your implant for a smaller one.
Follow up with your plastic surgeon would be the first step.  Make sure your plastic surgeon understands your concerns and goals.  It is also important that you see a plastic surgeon that has experience dealing with such complications.

Good Day,

Nicholas Jones, MD

Tom J. Pousti, MD · Answer

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. 
Given your concerns, 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.

Am I bottoming out? Breasts falling below incision line. (photos)

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Am I bottoming out? Breasts falling below incision line. (photos)

Answers (4)

Answer: Am I bottoming out after breast augmentation?

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