Dr. Linder sees patients every single day who arrive for breast revision surgery. We absolutely love performing redo surgery in that itís quite a challenge. Bottoming out can be very difficult to fix, either internal capsulorrhaphy, plicating the capsule and pulling the implant up and/or with an inframammary formal breast lift may be required to regain a normal shape, bringing the nipple back into the center of the breast and the implant upward superiorly to a normal shape and a normal position.
This is difficult to correct and one of the most difficult surgeries. Capsules are often very thin and often will not tighten appropriately. Bottoming out is usually associated with simply giving out of the pocket along the inframammary fold.
This could be due to several reasons. One is simply technical error. The plastic surgeon may simply lower the fold too much and the implant has now fallen by gravitational descent to a very low position and now the nipple appears to be in an overly high position.
It can also be associated with simply very large implants placed, especially above the muscle with inadequate postoperative support. In other words, women who do not wear their supportive brassieres or regular brassieres during the day and athletic brassieres at night, thereby gravity of the large implants is pulling the implants down inferiorly and causing the bottoming out as time goes on.
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.
It is essential that you see a Board Certified Plastic Surgeon before having your original surgery so that he or she has the technical ability to not lower the inframammary fold too much and thereby bottoming out is reduced over time.
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.