Update to my question: What procedure works for bottoming out and capsular contracture?

Photo as requested. "I went from an 34A to 34C (325cc) Medium Profile. Post op I noticed the left was dropping far quicker than the right breast. Dr advised that everything was in order and both breasts may not drop together. It has dropped by 3cm compared to the right breast. The implant moves to the side of my body when I lie down and can feel the implant through my skin. The right side breast is smaller, sits a lot higher and is hard. What would be the best way to rectify this?"

Doctor Answers 5

Remedy for Bottomed out Breast implant

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Surgery is the only effective remedy. Revision surgery is almost always more complex than breast augmentation. Correction techniques vary based on your plastic surgeon’s experience and skill sets. Always choose a board certified plastic surgeon with expensive revision experience as even in the best of hands recurrence is frequent especially if larger implants are used. Repair techniques include some of the following techniques and recommendations:
  1. Textured implants (“Velcro effect”)
  2. Use of Smaller Implants
  3. Maximum Submuscular Position (not just the pectoralis major but abdominis rectus below and serratus anterior on the side)
  4. Capsulorrhaphy (tightening the pocket by sewing in-folded capsular tissue together)
  5. Use of Biologic fabrics and other materials such as Acellular Dermal Matrix, “ADM” Alloderm, Strattice, “Silk” and others that can be used to reinforce the bottom of the pocket.
  6. Change of position of implant to a new pocket location “neo pectoral pocket”
  7. Internal Ryan Procedure (sutures binding the inferior mammary fold to stronger underlying tissues (e.g. fascial, periosteal)
  8. Removal of Implants and replacement of volume using your own fat (Fat Transfer).
The procedure is performed under general anesthesia on an outpatient basis most often using an existing scar or making an incision beneath the breast. Recovery is similar to your original breast augmentation procedure. Use of taping after surgery and prolonged use of a support bra is often recommended. It is far more important to pick the best plastic surgeon rather than trying to pick the best procedure as they are in the best position to guide you to the right decision.

Strattice for bottoming out and contracture

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Strattice is a material used for an internal bra, and is very helpful in supporting implants that have dropped or move too far to the side. It is also very effective at preventing capsular contracture, so it may actually be the answer for both of your problems. With contracture, usually the scar capsule is removed, so there is less coverage of the implant. Using Strattice adds the coverage and support back in addition to helping prevent recurrent capsular contracture.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Bottoming out?

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Solely based upon the photo, it looks like the breast on the your left( right side of photo) has bottomed out compared to the one on the opposite side. You probably will need a pocket adjustment to fix this.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Update to my question: What procedure works for bottoming out and capsular contracture?

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Although accurate advice would necessitate in person examination your picture and  description are helpful.  Based on this information, you are likely dealing with a breast implant encapsulation on your right side;  treatment may involve capsulectomy and/or the use of acellular dermal matrix. On your left side, it is likely that you are dealing with breast implant displacement/malposition; treatment would involve internal suture repair ( capsulorraphy) of the inferior and lateral breast implant pockets. You may find the attached link, dedicated to revisionary breast surgery examples, helpful to you. Best wishes.

Left breast implant dropping

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This is discussion even at our plastic surgery meetings.  First in my opinion, your left (photo) breast implant sits closer to where it was meant to be.  The photo right is too low and has bottomed out.  The star gazing nipple tendency is an indicator of the center of this implant below the nipple complex.

An inferior capsulorhaphy can fix this and if needed change to a textured implant and this will likely not occur again.

Peter J. Capizzi, MD
Charlotte Plastic Surgeon
4.9 out of 5 stars 93 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.