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Thread: Bottoming out/Big Implants

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    Default Bottoming out/Big Implants

    Its been a while since I posted here but, thought this might be a reason to come back for a visit.

    I'm a board certified Plastic Surgeon outside Chicago and I'm working with J&J on a device to correct bottoming out and prevent it from happening. For those who don't know, bottoming out occurs when the implant falls too low on the chest. I've attached a few pics which are worth a million words in describing this problem. The device is basically a sling contructed from mesh (the same material used in hernia repairs) which supports the implant and keeps it in place.

    Obviously, dancers are a prime group in need of this product since many have larger implants and most spend a good piece of their work day without a bra. Its also somewhat more important for you to look good without a bra than it might for someone who's income didn't depend on it.

    In any case, if there are women with bottoming out, failed bottoming out repairs, or those contemplating large (>600 cc) implants I'd be glad to try to help.

    Dr Frank
    Plastics Doc

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    God/dess Emily's Avatar
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    Default Re: Bottoming out/Big Implants

    I think half the battle with bottoming out is getting the right technique to begin with.

    it seems that crease incision and overs cause the most problems. Or to get under the muscle through crease or nipple, muscle and fascia must be cut, which are supposed to support the implant later on. This is one of many reasons why I think the trans-ax placement is so great.

    what do you think?

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    Default Re: Bottoming out/Big Implants

    I agree that overs (subglandular) implants tend to bottom out faster and attribute this to the fact that skin and breast tissue stretch pretty easily.

    I don't like the transaxillary approach. As a doc who sees a ton of botched breast augs, one of the most common problems I see is a "high riding" implant due to incomplete release of the pectoralis during a blind transax approach. This almost always means another surgical procedure.

    Also, if you develop capsular contracture or a deflation down the road its tougher to appoach via a transaxillary approach.

    Finally, getting a larger gel implant in via a transaxillary approach is nearly impossible.

    Just my two cents.

    Dr Frank
    www.ariasurgery.com
    Plastics Doc

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    God/dess Emily's Avatar
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    Default Re: Bottoming out/Big Implants

    well, I think it goes without saying that if you go the trans-ax route, that you should find a surgeon that is very good with the technique.

    It just seems that if it's done right, you avoid many of the common problems, including CC.

    But you are right, it's not very practical for gels.

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    Default Re: Bottoming out/Big Implants

    What about "double-bubble" with unders?

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    Default Re: Bottoming out/Big Implants

    I've got well over 600cc's with a crease incision. So far no evidence of bottoming out. When I first consulted my doc I asked about this. He said that the girls who tend to bottom out are the ones who had little breast tissue to begin with, and no natural crease. I started with b-cups, which did have a crease. The doc said that the implant would rest in the skin pouch of my natural boob, and this would make the double-bubble or bottoming out a very unlikely occurrence. It seems to make sense to me. I could also see how formerly flat girls would not have that breast pocket to fall into, and the implant would just slide down the chest wall if not properly supported.

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    Default Re: Bottoming out/Big Implants

    I hadn't meant to get into all complications of breast augmentation but, a couple points:

    1. Bottoming out and Double bubble deformity are totally different creatures. Double bubble typically occurs in women with submuscular implants inwhich their native breast tissue "falls off" the end of the implant. Often these can be fixed with a lift or moving the implant on top of the muscle or both.

    2. Moving the inframammary crease greatly increases your risk of bottoming out. While its necessary in many patients, doing it disrupts an important anatomic landmark that keeps the implant in place.

    3. Bottoming out can happen any time after your surgery - not just immediately postop. Smoking, heavy implants, skin weakened by sun or pregnancies, other surgeries like lifts all contribute to increase your risk of bottoming out.

    Dr Frank
    Plastics Doc

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    Default Re: Bottoming out/Big Implants

    I understand bottoming out, what that means....but could someone please explain the "double bubble" thing to me?




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    Default Re: Bottoming out/Big Implants



    Double Bubble. My biggest fear. Bigger than bottoming out. Fuck everything else, I don't want THIS and I told my doctor very specifically that this was the only and main thing I wanted to avoid.


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    AudreyLeigh
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    Default Re: Bottoming out/Big Implants

    When implants are placed behind the pectoral muscle, rather than in front of it, women whose breasts have begun sagging naturally can experience a unique complication commonly referred to as double bubble. While the implant remains in place, breast tissue sags bellow it, creating the appearance of two separate breast creases.



    Last edited by AudreyLeigh; 04-07-2008 at 10:32 AM.

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    Default Re: Bottoming out/Big Implants

    Who cares about natural feeling; I'm going above the muscle JUST to avoid this.


    Look like a woman
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    - My Great Grandmother Bessie's Recipe for Success

  12. #12
    AudreyLeigh
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    Default Re: Bottoming out/Big Implants

    So this "sling" is placed around the implant and attached to what? Interested in a like picture or something... I just posted about bottoming out and the lowering of crease because Im going from 325cc saline to 600cc silicone and will need my crease lowered - was worried about complications...

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    Default Re: Bottoming out/Big Implants

    Holy mackerel. I never heard about the double bubble thing before. Great. Something else to scare me off the surgery I should have had long ago.

    So, if you have problem boobs (i.e. moderate ptosis but plenty of natural breast tissue), I guess it's a really bad idea to go under the muscle, unless you do a mastopexy simultaneously? Is that correct?
    "Doc still loved true things, but he knew it was not a general love and it could be a very dangerous mistress." - John Steinbeck, Cannery Row


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    Default Re: Bottoming out/Big Implants

    K, this worries me lots.... I had lots of natural breast tissue before my BA, I'm under the muscle, I also work out lots and obviously due to work, don't wear a bra for at least 6-7 hours a day.

    So, let's say this double bubble happens (and OP I am sorry this thread got turned around) can it be fixed?




  15. #15
    mermaidnz
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    Default Re: Bottoming out/Big Implants

    *sigh*

    yep, mine are still fucked by bottoming out. and btw, theres not always a guarantee to op to fix it will work either.

    all it is is stitches under your implant to hold it back up, whats worse now is, that i have one perfect boob and one semi bottomed out one. might have looked a bit better whenthey were both on the same level.lol
    i give up!

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    Default Re: Bottoming out/Big Implants

    These are some scary pics. Lysondra, that made me cringe

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    Default Re: Bottoming out/Big Implants

    Quote Originally Posted by Lysondra View Post
    Who cares about natural feeling; I'm going above the muscle JUST to avoid this.

    You might want to consider overs that under the fascia. My implants we placed on the subfascial plane and I love them. I've got lots of compliments on the way they look and feel.


    I snapped a quick picture... it's not the best but whatever.
    Last edited by MissTaylor; 08-15-2007 at 04:24 AM.

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    Default Re: Bottoming out/Big Implants

    ^Wow. Those are quite lovely.

    i hadn't heard about that subfascial plane thing. interesting! i gotta go for some consults...
    "Doc still loved true things, but he knew it was not a general love and it could be a very dangerous mistress." - John Steinbeck, Cannery Row


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    Default Re: Bottoming out/Big Implants

    Isn't this mesh sling the same as what's called the internal bra? I didn't think that was all that new...

    I'm getting 800cc implants next month, over the muscle. But I've got 625s now and had significant breast tissue with a definite crease. My implants settled right into my natural breast pocket, and I expect the new ones to do the same. It might be nice to get the sling if I wanted a lift. Perhaps on the 3rd set...

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    Default Re: Bottoming out/Big Implants

    1. Internal bras per se aren't new...in the past they've been designed to replace a breast lift by wrapping the whole breast in mesh. This doesn't do that...it just supports the implant "behind" the breast.

    2. Subfascial placement places a quarter milimeter strip of "schmutz" over your implant if you can raise it in the OR so it doesn't shred...almost NO ONE has embraced this as something worthwhile. Lots written about it but, anyone who does a lot of breast will tell you - its all hype.

    3. Likewow has it down...so far 100% success with mesh sling. Glad you're doing well.
    Plastics Doc

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    Banned i.breathe.in's Avatar
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    Default Re: Bottoming out/Big Implants

    everyone tells me how great my implants look but by your pics you posted doc mine are starting to bottom out....i didnt think hey were but, oh....ok.

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    Default Re: Bottoming out/Big Implants

    Definitely not trying to make anyone self conscious or, worse, paranoid. Just knew this would be an well informed and receptive audience.
    Plastics Doc

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    Default Re: Bottoming out/Big Implants

    well heres mine, what do you think? they are 450cc unders....
    Last edited by i.breathe.in; 04-30-2008 at 02:03 PM.

  24. #24
    Lola Rose
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    Default Re: Bottoming out/Big Implants

    from my perspective, they're pretty bottomed out. but i don't really think it makes em look bad.

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    Default Re: Bottoming out/Big Implants

    now that i know i am bottomed out how much did this surgery run you? i need to know what im getting into finantially if im going to attempt to fix them....that would make sense why they are sore all the time.

    [QUOTE=likewow;1170599]I had severe bottoming out and I had a polypropylene mesh sling put in to correct it, along with a full lift and an additional 300cc's added (went from 800 to 1100.) It's been almost three months and they are still perfect, whereas at this point after my first boob job I had already bottomed out quite a bit. I did a lot of research on this procedure before having it done because it is still pretty experimental.

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