What's happening? Bottoming out, rippling, uneven sizing! Should I switch to smaller implants or raise breast crease?

Greetings, I am a small frame 5"4 105lbs and a athletic person. I naturally was a deflated small c natural tear drop shape. I had high profile allergen 560 implants under muscle with crease incision with an areola reduction. The right breast dropped alot and now lows matronly. I had left Brest lowered crease in hopes to match. I am now worried as left breast has rippling in cleavage and right breast you can feel the implant underneath and from sides.. thank you in advance

Doctor Answers 14

Breast implant problems

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I believe your implants are way too large for your frame which increases these types of complications. Switching to smaller implants and capsule tightening with or without strattice will likely be needed. Discuss your concerns with your surgeon. Best of luck

Josh Olson MD

What's happening? Bottoming out, rippling, uneven sizing! Should I switch to smaller implants or raise breast crease?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You should consider both switching to smaller implants and capsulorrhaphies,  a procedure to elevate your breast crease. Your current implants are much too large for your chest dimensions. This is why you have experienced your current complications. Thank you for sharing your photos and question. Best wishes. Dr. Gregory Park, San Diego Plastic Surgeon.

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 177 reviews

Uneven big boobs

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

This has a lot to do with pocket control, your implants are wider than your body and are out of control! The right is too low and more lateral, the left too high and too medial. What's a girl to do?

First, you need the correct implant. The base width should match the base width of your breast... or else you will continue have either too lateral or too medial implants. These implants look too big and too sloppy on you and are ruining your whole athletic vibe. I strongly encourage you to downsize. Think 400cc max.

Next you need capsular control. Depending on the thinness of your capsule, you need either a capsullorrhaphy (reset pocket with sutures) or a ADM internal bra (necessary if you have a thin/poor capsule).

This is fixable but you have to really commit to fixing it with a whole for real surgery. As a plus, it will look awesome...

Lisa Cassileth, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 16 reviews

Revision Breast Augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}


I think that any consideration for repair should include a reduction in volume of the implants, as your current implants are not only a major contribution to your malposition, but are also simply too large for either your soft tissue envelope and your chest wall. So, switching to smaller will help on two fronts: rippling and malposition. An important part of the repair will be closing down and reinforcing your internal scar capsule, called capsulorrhaphy. This can be done with or without mesh or ADM reinforcement. Finally, consideration should be made to implant type. You are an excellent candidate for form stable, shaped, and textured devices. Despite reticence from many of my American colleagues, the data shows they have the lowest complication profile of all implants, and I have found they are less apt to drift down and out (malposition). Best of luck! 

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

You do need your bottomed out side

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

revised with elevation of the fold and downsizing to better match the other side, unless there is a lot of fluid found in the pocket at the time of your procedure.  This would be based on the assumption you really like the good side.  Otherwise downsize both (more on the bottomed out side) and consider a skin only vertical mastopexy to shorten the lower pole and you still need the lower side elevated.  In the end, its really up to you as to what you would want.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast implant size problems #plasticsurgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You appear to have issues with implant positioning and soft tissue coverage. Your right implant appears to have 'bottomed out' beyond the existing infra-mammary fold. Your implants appear to be quite large for your small body size. If you presented to my clinic, I would recommend down-sizing both implants substantially and then reconstructing your infra-mammary support with Strattice.

560 cc HP breast implants >> bottoming out and asymmetric.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

So sorry to hear of your experience.  This is not that unusual when a patient or doctor selects a large implant and has to significantly lower the breast crease to accomodate it.

In my practice I would recommend capsulorrhaphies and exchange to significantly smaller implants.  I have a post operative support regiment for the initial 6-8 weeks of healing to reduce the risk or recurrence.   Although i understand the rationale for textured implants, my practice is to use mid profile smooth silicone implants to reduce the risk of rippling and possibly reduce the risk of ALCL (the latter may be more controversial).  

Seek a skilled and experienced surgeon in your area to help you.  The potential for improvement is dramatic IMO.


Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca 

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 32 reviews


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}


The photos definitely demonstrate what you are describing. Both bottoming out and slight double bubble deformity. I wouldn't wait on this. After consulting with a plastic surgeon, you may likely need to downsize and under go fold repair.

Switch to textured (they hold better) and decrease your projection to moderate profile plus. high profile implants have a hammering effect on the inframammary fold.

Daniel Barrett, MD, MHA, MS
Certified, American Board of Plastic Surgery 
Member, Am. Society of Plastic Surgery

Daniel Barrett, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 84 reviews

Implants big for frame

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thanks for the great question and the photos. I'm sorry you're not happy with things. In my opinion, the main issue here is that your implants are too big. One of the issues with big implants is that they are very hard for the body to support. Because of this, they end up slipping underneath the incision and bottoming out. 

What you will likely need is to switch to smaller implants and have a new fold created. Sometimes this is done using a mesh to help resupport things. It's kind of like an internal bra. The rippling your feeling along the bottom is where the muscle has been released and the implant is palpable. This is also made worse because of the size of the implants.

As someone else recommended, make sure to see someone who specializes in breast to see what your options are. Best of luck!

~Dr. Sieber

David A. Sieber, MD
San Francisco General Surgeon
5.0 out of 5 stars 40 reviews

Large Breast Implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thanks for the photos.  Judging from your height and weight and the photos, the main problem you have here is that the implants are just too big for your body.  This has resulted in loss of fold control on one side and you are very close to symmastia as well.

Your revision surgeon should include downsizing your implants, using textured implants, and perhaps the use of ADM.

Make sure you see a board certified plastic surgeon who has experience in breast revision surgery.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 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.