"BA with silicone 4 months ago. Feel pain on the bottom of both and on the side (cleavage) of the right side. Feel flat on the top."


DR. POUSTI: Do I need a revision for bottoming out?

I am sorry to hear about your concerns after breast augmentation surgery. I think your concerns are appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement (“bottoming out”).

Generally speaking, signs of breast implant bottoming out include:

1. Breast implant “sits” too low on the chest wall.

2. Excessive palpability or visibility of the breast implant along the lower breast pole.

3. Nipple/areola complex seems to be sitting relatively high, because the breast implants have settled too low.

4. Discomfort along the lower breast pole (secondary to pressure from the underlying implant).

5. Relative paucity of upper pole breast implant volume compared to lower pole volume.

6. Increased visibility of a infra mammary fold scar (higher on the breast mound).

Patients with breast implant bottoming out usually benefit from >revisionary breast surgery which typically involves capsulorraphy (internal suture repair). Sometimes, depending mainly on the patient’s history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh. This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation.

In my opinion, careful attention to postoperative activity restrictions is one of the keys to success. In my practice, I ask patients to keep their elbows by their sides for at least first two weeks after the procedure is performed. Longer-term, certain activity (depending on exactly what procedure is performed) may also be restricted in an effort to avoid the potential for implant malposition recurrence.

Best wishes.

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