Bottoming Out
Dr. Linder sees patients every single day who arrive for breast revision surgery. We absolutely love performing redo surgery in that it’s quite a challenge. Not all breasts can be made perfect and trying to mold a breast and reshape it can be difficult, to say the least. Some of the most difficult surgeries to repair are bottoming out of breast implants. Patients whose implants have inferiorly displaced over time or that were malpositioned from the beginning can be very difficult to fix. Two methods of repairing a bottomed out breast include:
Open capsulotomy superiorly along the infraclavicular region in order to allow room for the implant to be superiorly displaced; and tightening of the inframammary fold, which can be performed either by an internal capsulorraphy trying to reapproximate the internal inframammary fold capsule superiorly, suturing it upon itself. This often does not work and can fail with time, especially with heavy implants.
Formal mastopexy using the inferior T Wise-pattern lift or an inframammary lift simply removing skin along the inframammary fold and tightening up the fold along the pectoralis major fascia.
In any case, bottoming out can be successfully repaired, and may require different components as described and scarring may be significant, including breast lifts. One way to prevent bottoming out is by performing the surgery in the correct fashion early on. In other words, Dr. Linder performs periareolar dual plane technique by going under the areolar, under the nipple, we’re able to release very delicately and very accurately the attachments of the parasternal and the inframammary fold pectoralis major muscle, which allows the implant to be set in the precise position. However, patients who arrive elsewhere for transaxillary or transumbilical approach often end up with malposition of the implants because it’s more difficult to predict an absolute pocket and the pocket may be released too much along the inframammary fold which leads to bottoming out immediately.
Secondarily, women who do not wear supportive brassieres over a long period of time may develop bottoming out simply due to descent of the implant and gravity causing the weight of the bag to weigh down the inferior pole of the breast. Therefore, we have all of our patients wearing underwire brassieres after they have healed six to eight weeks postoperatively.
Stuart A. Linder, M.D., F.A.C.S. is a Beverly Hills plastic and reconstructive surgeon specializing in breast augmentation, liposuction, tummy tuck, and more.
Dr. Linder is certified by the American Society of Plastic and Reconstructive Surgeons and is a diplomate of the American Board of Plastic Surgery.
READ ARTICLE
Skin Deep Magazine
"Reasons For Reoperation:
Breast Revision Surgery"
Contributing Writer:
Dr. Stuart A. Linder,
Board Certified Plastic Surgeon
January 2006
Stuart A. Linder, M.D., F.A.C.S. Beverly Hills Breast Revision Specialist
9675 Brighton Way Suite 420 - Beverly Hills, CA 90210
Phone: (310) 275-4513 - Fax: (310) 275-4813
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