Severe Recurrent Bottoming Out
The patient presents with a severe deformity after she had breast augmentation performed by a different surgeon twice, as well as a breast lift. At this point the implants have fallen to a significantly low level with severe bottoming out as seen in the preop photo. She also has severe breast asymmetry with the distance from the right nipple areolar complex 9 cm and 12 cm from the left inferior areolar to the inframammary fold. In order to reconstruct this difficulty deformity, the patient will need to have the implants removed and replaced with high profile saline implants as well as secondary formal mastopexy as well as inferior open capsulorraphy to reposition the inferior capsule superiorly. The patient’s postoperative photo shows at six weeks, the nipple areolar complexes are now equal and symmetric, found centrally in the middle of the breast, the scars are healing nicely, the patient has nice upper pole fullness, as she desires the high profile, desiring a slightly rounder shape implants. The tightening of the inferior capsule has brought the implants up nicely, allowing fur superior retropositioning of the implants and complete correction of the severe bottoming out. Bottoming out can occur due to descent of the skin over time. This may occur with larger implants and may also be associated technical error where the inframammary fold is lowered too much aggressively by an inexperienced plastic surgeon. Only Board Certified Plastic Surgeons should be performing this difficult bottoming out procedure.