Bottoming Out After Breast Augmentation

Three Weeks Post-op BA and BL, Bottoming out in Right Breast? I had 300 cc silicone moderate profile smooth round implants. I was 32A and wanted to achieve 32B, a natural look. I am starting to worry that my nipples might be too high and the right breast is starting to bottom out?

Doctor Answers 24

This is not really bottoming out; this is how things look after many vertical lifts.

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You have had a vertical lift, and may have had a short horizontal component (crease scar) that I cannot see from your photograph. Usually the vertical lift has a long subareolar scar length which sometimes crosses the inframammary crease, and adding a horizontal elliptical excision is designed to try to shorten that excessively long vertical scar length.

This is not a "double bubble," which usually refers to implant mound below your own native inframammary crease, Your implant position looks pretty good as related to your inframammary crease; you just have "extra skin" that is loose and unfilled. I believe a better choice of mastopexy design would have excised that excess skin and tightened up that area nicely. But your surgeon, for one reason or another ("one operation fits all"?), chose a vertical lift, which by design removes skin in one dimension only, when in your case there was the excess in the perpendicular direction to consider. Frankly, that is why the Wise or anchor pattern is most widely used: it corrects the skin excess in both horizontal and vertical dimensions, and thereby gives a more pleasing breast shape when there is significant laxity or deflation. But lots of surgeons, and most patients want more shaping from less incisions. As you now see, that doesn't always work out. (And, the second operation will give you the scars that you or your surgeon were trying so hard to avoid.)

Since your breasts must have been considerably deflated to require lifting plus implants, your loose skin brassiere required "tailoring" to create a tighter 3-dimensional breast shape. While vertical lifts can give nice improvements in some breast lift cases, there is a tendency to over-utilize this approach in patients who would be better served, IMHO, by a full Wise-pattern (anchor) mastopexy, which is designed, drawn, and cut to tailor the loose breast skin in more than just the vertical dimension. It's not just about nipple elevation; it's about proper position atop a beautifully-tailored skin brassiere to give a pleasing natural shape, not just a single vertical scar. For an example of vertical lifting gone bad, click on the link below.

I tell you this not to criticize your surgeon or his/her choice, but to educate you that this is actually a pretty good result from this type of lift plus implants. What you see are the limitations of this procedure!  Your nipple position looks pretty good, but only direct measurement will tell. The problem I see is that you still have loose and unresected (extra) skin in the lower pole of both breasts. As your implants drop over time (how much and how long it takes are individual to each patient), I would expect that loose skin to be filled out somewhat, but then your nipple/areola position may look too high on your breast mound. This could have been avoided by excising the skin along your crease (the horizontal component of a Wise-pattern or anchor mastopexy), the very part of this operation that was avoided (to avoid the scars), but was needed!

My best advice: let things settle and heal for 6 months. then see one or more ABPS-certified plastic surgeons for advice about what to do to give you the look, size, and natural appearance you desire. That may be from your original surgeon, if he or she is willing to consider something other than a "one vertical lift method fits all" approach. Or it may be from someone who is able to see what the problem is and how to best correct it. Best wishes, and please don't rush to premature re-operation!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Bottoming out after breast augmentation

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Hello and thank you for the question.

In review of your photograph, your results are not consistent with bottoming out. Given that you are only a few weeks out from surgery, the implants will continue to migrate caudally, thus filling out the lower pole of the breast with time. At  the 6 month mark, you will have a better idea of what the definitive shape of your breast mounds will be. My advice, for now, is to be patient. 

Best of luck,

Glenn Vallecillos, M.D., F.A.C.S.

Glenn Vallecillos, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 30 reviews

Am I bottoming out

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Since you are only 3 weeks out from your surgery assessments would be premature.  At this point you should continue to do as your surgeon tells you.  I see nothing that needs immediate attention.  After a combination of both augmentation and lifting many changes take place.  The hardest thing to do is to be patient and allow the healing process to take place.  Again listen to your surgeon.

Randy Proffitt, MD
Mobile Plastic Surgeon

What is bottoming out?

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In the photo I see an early (really early!) result that has a lot of edema in the breast tissue itself.  Bottoming out is when the implant migrates downward, below it's intended location.  You can see the upper pole of the implant way up high.  When it drops, things will look better.  Are you wearing a breast strap or massaging?  These are good questions for your doctor.  Symmetry is good, incisions look fine, the operation is an early success.  

Ritu Chopra, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 reviews

Breast Implants and Breast Lift - Implants Have Not Descended at 3 weeks; ? Need for Revision

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Hi Pleasanton7862,

Well, the good news is that you're only 3 weeks out and, to be honest, you look pretty good at this stage!  It is common for implants not to have descended adequately at this stage, since there is tightness at the skin level which contributes to submuscular implants taking a long time to descend.  In fact, since implants do descend over time, it's almost good that they still have a way to go.

You need to give it some time - at least a few months (like 3 months minimum).  And stay in touch with your own plastic surgeon.  It looks like you've had some nice surgery performed and in the (unlikely) event that something further would have to be done, the best way to do so is with that surgeon.  So stay in touch!

I hope that this helps, and good luck,

Dr. E

Breast augmentation

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This is not bottoming out. It looks like the implants have not settled yet and you have some breast tissue below the level of the implant that you are looking at. As the implant drops into position it may fill this area out. Bottom line is you are only 3 weeks out from surgery and you need to be patient.

David E. Kim, MD
Beverly Hills Plastic Surgeon
4.6 out of 5 stars 106 reviews

Breast Enlargement PoblemsArticle

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Quit worrying.  Your surgeon has done a nice job.  When there are two of something there is always a little difference.  Let things heal and be patient.  At one year, if you have a little bottom fulness or assymetry it is very easy to adjust ths.  Go discuss this with your surgeon.  Many patients experience too much anxiety after breast surgery and most of the things they worry about never come to pass.   My Best

Bottoming out after a breast augmentation

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You picture that you provided reveals an early result with a lot of healing to do.  You will find that the implants will get softer and more natural looking with time .  Also, the lower parts of the breasts will change significantly in the next two to three months.  Patience is your best friend.  Don't do anything rash.  I's sure your plastic surgeon has advised you of the same.

Wishing you all the best,

Talmage J. Raine MD FACS

Talmage J. Raine, MD, FACS
Chicago Plastic Surgeon

Bottoming Out After Breast Augmentation

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I can not find any reason to disagree with you from the viewing of your posted photo. Best to allow at least 3 months of healing before requesting a revision or seeking another surgeon for a revision. 

Revision breast augmentation is usually successful.

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1)  Of course, do nothing for six months, but unfortunately you will probably want a revision eventually.  And sometimes, things improve on their own.

2)  You do not have "bottoming out".  If you want to give it a popular name, it is the "double bubble" deformity.  Your lower breast tissue is hanging below the breast implants, specially on the right side.  That is what you are seeing.

3)  This can be corrected by lowering the breast implant pockets somewhat.  Also, since you wanted to be a B cup, the implants can be replaced for somewhat smaller ones.

4)  Another alternative ( which can be done alone or together with the above ) is to revise the breast lift and tighten and lift the lower poles of your breasts.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

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.