Breast Revision, Bottoming Out Beverly Hills
Bottoming out can be a significant problem with breast augmentation surgery. In fact, implants placed in a perfect subpectoral or dual plane pocket over time can bottom out. This can occur when patients either have increased skin laxity to their breasts, weight fluctuation and change or have poor inframammary fold support with underwire bras during the day and athletic sports bras during the evening. Over time, heavier implants can certainly cause the skin to sag and increased laxity can certainly occur. The below example shows a patient who over time, after two years postoperative, developed significant bottoming out of her right implant.
The upper pole of the pocket became completely scarred in and developed scar contracture. The implant was inferiorly displaced and the patient had bottoming out. In order to correct this specific result, skin laxity was addressed along the inframammary fold. 1) removing skin along the inframammary fold and an inframammary breast lift procedure; 2) superior open capsulotomy and capsulectomy releasing scar tissue along the upper pole of the breast pocket; and 3) replacing of the moderate profile saline with high profile saline implants has greatly reduced the bottoming out of her right inframammary fold. Please see her postoperative view showing enhanced cleavage, nipple position shows more symmetry and at five weeks postoperative, the inframammary fold appears to be significantly improved. This is an example of bottoming out with correction by inframammary fold skin elevation by skin tightening, open capsulotomy and high profile implant exchange.