Re-implanting after explant. how high is my risk for bottoming out? (Photo)

Question

F.29.5'3 I had my breast augmentation in 2016 (450cc) and in 2019 I removed them with en bloc capsulectomy. I regret removing them so I am looking to re implant. Although I've heard the risk of bottoming out is higher. I don't want to go as big as I was originally also. How high is this risk? And what can be done to reduce this risk?

Daniel Barrett, MD · Answer

Dear rapa94,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Tyler Frew, MD · Answer

Hi there,
That is a very hard question, it would depend on the qualitly of your tissues and IMF (inframammary fold). I would see someone in person.
In general, the smaller implant will decrease the risk of bottoming out. Also, adding lower pole support such as mesh will also decrease the risk.
All the best

Connie Hiers, MD, FACS · Answer

Going smaller than the original implants will help decrease the risk of bottoming out. Also, mesh can be used if needed.

Mats Hagstrom, MD (license on probation) · Answer

The chance of quality outcome is significantly lower than a primary augmentation based on your history.
Once you take the implants out, the space gets covered in scar tissue, which does not stretch and does not have the pliability of virgin tissue.
For this reason, the implant is likely to have some distortion And the potential outcome is dependent on the quality of your tissues, including how much scar tissue you have.
The risk of bottoming out should be preventable, but this again has to do with how previous surgeries were done, and the quality of your tissues.
Working with smaller implants is always safer, especially minimizing the chance of bottoming out.
Unless you’re going back to your previous plastic surgeon, you should collect all your medical records from previous operations including complete sets of before and after pictures and all operative reports and bring those when consulting with providers for re-augmentation.
Best,
Mats Hagstrom, MD

Re-implanting after explant. how high is my risk for bottoming out? (Photo)

Answers (4)

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