A successful breast augmentation surgery not only relies on the skill of the surgeon but also the anatomy of the patient. Bottoming out is a complication that can occur either through an intentional or unintentional lowering of the breast crease or fold. A surgeon may need to intentionally lower the fold of the breast if a patient has a tight fold or if the patient is desiring a larger implant than their at anatomy will accommodate. In addition, this can happen if an implant is too large or too heavy for a patient’s skin elasticity. All of these scenarios result in an implant dropping lower on the chest then what would be ideally desired. The weight of the implant or trauma from surgery contributes to the overall final result.
As a consequence, a patient may see the implant slowly descending on the chest or the nipple appearing to be higher on the implant than what it was originally. This appearance will often prompt patients to seek out professional help to correct the changes that have occurred. Fortunately, there are a number of different surgical techniques to help correct bottoming out of a saline or silicone breast implants.
Correcting the inciting cause is the primary goal of the surgery. If the implant is deemed to be too large then often we will recommend downsizing the implant. If it appears it was related to a surgical technique, then often the same implant can be kept in place. An, in-person consultation would need to be completed to determine which of these were the primary cause.
The primary correction of this problem is what is been termed an “internal bra” technique. This involved suturing the breast capsule that normally develops after the placement of an implant. The capsule is a strong fibrous structure that can serve to support the weight of the implant. Frequently, this is all that is needed to do to correct the bottoming out. Often the capsule is simultaneously released in the upper aspect to facilitate the ease of movement of the implant in an upward direction. This can be done from side to side as well.
Another potential issue related to bottoming out is a phenomenon called a “double bubble”. This happens when the implant drops below the fold but the crease of the breast creates a second crease in the implant. This forms an indention in the lower aspect of the breast creating two bulges – commonly termed a “double bubble.” This too can be corrected through the process of tightening the internal capsule to its original, desired location.
There are additional, more aggressive options that exist to correct situations where the patient have had a reoccurrence of this problem or they are known to have a particularly weak capsule. In theses situations, we commonly employ something called in acellular dermal matrix (ADM) which is a collagen sheet that can be inserted into the body to help support the lower aspect of the breast. This can be used in all areas of the breast capsule the most commonly seen in a bottoming out type situation. We will discuss this more in upcoming blog post.
If you are interested in learning more about your options for correcting bottoming-out, call our office to schedule your complementary, in-person consultation with Dr. Marin at 858-638-9800.7:33 PM