Q: What is Dr. Eppley’s experience in fixing breast implants that have bottomed out? What is the success rate in it staying fixed?
A: Bottoming out in breast augmentation is when the implant falls below the level of the lower breast crease. There are numerous factors which contribute to this problem, but the main one is when the size of the implant exceeds the ability of the tissues to hold it up. This is a problem that is usually seen long-term, not immediately after surgery. The implants may have initially been in good position but have dropped over time. Sometimes this may not occur for years.
When this problem is seen right after surgery it is the result of the pocket dissection going below the attachments of the lower breast fold. This is acute fold attachment disruption not its weakening over time.
Either way, the treatment of breast implant ptosis (bottoming out) can be done by two different methods. The most common approach is to suture the attachment of the breast fold back onto the chest wall, which pushes the implant back up. This is the simplest approach but loosening of the sutures can happen and dropping of the implants can happen again. If this were to happen it would usually occur within the first six weeks after surgery.
The other approach, which is newer, is to insert a lower sling of allograft dermis between the pectoralis muscle and the chest wall. Like an internal bra, this tissue supports the bottom part of the breast better. It is more reliable in terms of success but is much more expensive due to the cost of the dermal graft.
Dr. Barry Eppley