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 Bottoming out is a complication from breast augmentation surgery that involves the migration of the implants downward. There are 2 distinct types of "bottoming out" that may occur:
1 - Inframammary fold descent
This is when the implant is placed too low on the chest wall either through
- Over dissection of the implant pocket
- The implant is too large for the area of skin and breast tissue due to thin breast tissue. The placement of a breast implant that is too large or heavy may stretch the fold too low
2 - Inferior pole stretch
This is caused when the skin of the lower pole is stretched due to:
- Thin skin with minimal breast tissue support
- Post capsulectomy
There are several techniques that can be used to correct bottoming out. The technique used depends upon the degree of the complication and the cause of the complication as mentioned above. Some techniques used are:
Create an internal bra that will provide support to the implant.
This technique uses capsulorrhaphy and the pec extension technique. It is similar to a breast reconstruction technique where a piece of Strattice mesh is used to create an "internal bra" that will support the implant. Strattice mesh is an acellular reconstructive tissue matrix that is designed to support tissue regeneration. It is derived from porcine dermis and is used in a variety of breast revision procedures where tissue is inadequate.
The procedure begins with an incision located where the previous incision was made. The capsule is dissected from the pectoralis major muscle. The capsule is cut open and the implant is removed. The excess lower capsule is closed by suturing the upper and lower capsule together. Part or all of the capsule may be removed. A sizer is used to determine if the breast fold and implant location are where they should be. Once the implant and fold are at the desired positions, a piece of mesh is placed in the pocket. Once the mesh is in place, a drain is placed and the incision is closed.
Recreate the Inframammary Crease
To recreate the inframammary crease, the lower area of the breast pocket is reinforced with internal sutures thus raising the breast implant to create a more natural breast crease or fold. Whether to do this procedure or reinforce with strattice depends upon the thickness of the tissues.
Create a NeoPectoral Pocket
This procedure creates a new space above the old capsule that will correct the case of a bottomed out implant due to a fold descent. It will not fix a patient with inferior stretch.
Excise Skin - Mastopexy
This procedure involves performing a mastopexy to correct inferior pole stretch. This technique is used when the fold is in the proper position but the skin and soft tissue from the nipple to the fold has stretched. Sometimes using strattice as mentioned above corrects the problem by taking the weight off of the skin but sometimes skin needs to be excised.
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