Breast augmentation is one of the most popular cosmetic procedures out there. And since cosmetic surgery is real surgery, some complications are inevitable. Breast augmentation revision is a specialty unto itself within plastic surgery. One such complication that requires a breast augmentation revision is bottoming out of the implant as shown above.
What is ‘bottoming out’ in breast augmentation?
In an ideal situation, a breast implant sits behind the breasts in perfect symmetry. However, if the fold under the breast, the inframammary fold, is disturbed, the implant can bottom out. The fold is usually very adherent to the chest wall.
Bottoming out can occur if the fold is inadvertently released from the chest wall. This can occur if the implants are too large and put too much pressure on the fold, such that it pulls away from the chest wall. And sometimes the fold must be lowered to accommodate a larger implant. If that’s done, the fold will bottom out if the fold is not affixed back to the chest wall with a suture.
If bottoming out occurs, there are several options. One option is to create a new pocket. However, two things are important when doing this. First, the implant should remain under the muscle so the implant continues to be camouflaged and look as natural as possible. Secondly, the pocket needs to be strong to minimize a recurrence of bottoming out.
Neosubpectoral pocket video
That’s where the neosubpectoral pocket technique comes in. This is a confusing concept so the video below will help. But essentially, the physician uses the naturally occurring scar tissue around the implant (the capsule), to help make the new pocket. A new pocket is made between the muscle and the capsule and the implant is placed here. That way, the implant is still under the muscle and on top of the capsule.
Using mesh to treat a bottoming out breast
The alternative, is to use mesh or some other material to secure a new inframammary fold. In this particular case below, GalaShape from Galatea was used to secure the new fold for a very robust repair.
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