Is my left breast bottoming out? (Photo)

I'm 7 weeks post op with my first breast augmentation, HP textured, round implants. My left breast is lower, looks bigger and is softer than the right and the scar is slightly above the crease fold, is it bottoming out?

Doctor Answers 5

Bottoming out

Hi there
it is still early to see how things will settle, so the breasts may even out, but there is a degree of asymetry, and it could be what you refer as bottoming out, which is when the implant pocket stretches inferiorly
you may need revision surgery but not before 6-9 months post op, to give enough time for things to settle
mall the best

 
 

Breast implants bottoming out

You do have degree of assymetry between tthe two breasts. However, it is very early to draw conclussions as it takes 3 to 6 months for things to settle, before you should contemplate having any thing done. There does appear to be a bulge in the lower pole on the bigger side, with increased distance from the nipple to the crease. In addition to this if you are saying that the scar is above the crease, then it does suggest that the implant is lower on this side. For the moment, do give it some time and see how things go.

Bottomed out implant

From your photographs it appears to me that the right implant is 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.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

Is my left breast bottoming out? = follow up with your plastic surgeon #breastaugmentation #breastimplants

Patients with questions and concerns about their breast augmentation with implants healing process should address those concerns with the plastic surgeon that performed the operation

John Mesa, MD
New York Plastic Surgeon
4.9 out of 5 stars 110 reviews

It does look lower

After a breast augmentation it is normal for implants to "settle."  As that happens, the implant will tend to fall lower on the chest wall.  When I look at your photographs, it appears to me that the right side is lower, has less fullness at the upper pole (the top), and I can see the scar on the breast.  Were these photos taken in a mirror so that they are reversed?  At any rate, there is a small amount of asymmetry to your breasts.  At 7 weeks, I would have my own patients try wearing an underwire bra around the clock, except to shower, for 6 weeks. The scar tissue is still forming around the implants and this might get you a slightly better result.  It would not be unlikely that, if this look is unacceptable to you, you may very well need a revision.  I would not do such a revision for at least 3 months.  I would check with your Plastic Surgeon for their thoughts about treating this right away.  Good Luck!!

Daniel Sherick, MD
Ann Arbor Plastic Surgeon
5.0 out of 5 stars 12 reviews

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