Revision for bottoming out—are dissolvable sutures, permanent sutures or internal bra best?

I have 325cc HP silicone implants from 1.5 yrs ago that bottomed out—left lower than right. I hope to exchange for 225-250 cc, and raise the implants 2-3 cm. What is the best procedure for this? I prefer dissolvable sutures, but is there a high chance of BO recurrence? Would ADM internal bra, or permanent sutures result in more precise, symmetrical and longer-lasting effects? Which is safest? Please advise if you have experience in this type of BO capsulorrhaphy with inframammary incision.

Answers from doctors (4)


Tim Sayed MD, MBA, FACS

Published on Aug 09, 2017

It is hard to counsel anyone with a complex revision question without photos and an exam. Internal sutures to tighten or raise the capsule are either permanent or very slowly dissolvable to allow solid scar tissue to form to support the repair.

ADM is another approach to provide support but is not necessary in many cases as it adds significant cost and an additional foreign body to the healing site. It is more of a question of what techniques a specific surgeon needs to employ for a unique case, which requires a direct discussion and exam in the office.

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Answered by Tim Sayed MD, MBA, FACS

It is hard to counsel anyone with a complex revision question without photos and an exam. Internal sutures to tighten or raise the capsule are either permanent or very slowly dissolvable to allow solid scar tissue to form to support the repair.

ADM is another approach to provide support but is not necessary in many cases as it adds significant cost and an additional foreign body to the healing site. It is more of a question of what techniques a specific surgeon needs to employ for a unique case, which requires a direct discussion and exam in the office.

Published on Jul 11, 2012


Stephen Greenberg, MD

Published on Jun 22, 2017

Thank you for your question.

If your implants have bottomed out (have fallen below your breast crease) and you wish for them to be corrected, it will require a surgical intervention to help reinforce the inferior pole of your breast pocket, commonly referred to as a capsulorrhaphy. A capsulorrhaphy repairs the inferior breast capsule utilizing permanent internal sutures and essentially shrinks or reduces the size of the implant pocket to keep your breast implant in their proper position and prevent its descent below your natural inframmary breast crease. Ultimately, this procedure will improve your breast shape and provide you with better overall breast symmetry. Depending on the particulars of a patients case, it may or may not be advised to also place ADM (or an acellular dermal matrix) in the inferior pole at the same time to help thicken up and support the inferior breast pole. This is commonly advised when patient presents with thin skin and/or rippling of the inferior pole. If patients are also adamant about keeping a larger size implant which can put extra stress and weight on the pocket repair, ADM may be required.

Displacement of implants in the breast/implant pocket (both inferiorly and laterally) are one of the most common complications of a breast augmentation procedure. As a result, many board certified plastic surgeons who specialize in breast augmentation procedures are well equipped to surgically correct this. In my practice, I perform many breast revision procedures in patients who present to me at consultation with similar experiences and after evaluation and surgical correction patients are extremely satisfied with their result. I am happy to hear that you are interested in exchanging your implants for smaller ones as this will also increase your risk for a great final result.

I hope that you find this helpful and I would encourage you to schedule a consultation with a board certified plastic surgeon who is well experienced in these procedures for evaluation and for the best advice.

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Answered by Stephen Greenberg, MD

Thank you for your question.

If your implants have bottomed out (have fallen below your breast crease) and you wish for them to be corrected, it will require a surgical intervention to help reinforce the inferior pole of your breast pocket, commonly referred to as a capsulorrhaphy. A capsulorrhaphy repairs the inferior breast capsule utilizing permanent internal sutures and essentially shrinks or reduces the size of the implant pocket to keep your breast implant in their proper position and prevent its descent below your natural inframmary breast crease. Ultimately, this procedure will improve your breast shape and provide you with better overall breast symmetry. Depending on the particulars of a patients case, it may or may not be advised to also place ADM (or an acellular dermal matrix) in the inferior pole at the same time to help thicken up and support the inferior breast pole. This is commonly advised when patient presents with thin skin and/or rippling of the inferior pole. If patients are also adamant about keeping a larger size implant which can put extra stress and weight on the pocket repair, ADM may be required.

Displacement of implants in the breast/implant pocket (both inferiorly and laterally) are one of the most common complications of a breast augmentation procedure. As a result, many board certified plastic surgeons who specialize in breast augmentation procedures are well equipped to surgically correct this. In my practice, I perform many breast revision procedures in patients who present to me at consultation with similar experiences and after evaluation and surgical correction patients are extremely satisfied with their result. I am happy to hear that you are interested in exchanging your implants for smaller ones as this will also increase your risk for a great final result.

I hope that you find this helpful and I would encourage you to schedule a consultation with a board certified plastic surgeon who is well experienced in these procedures for evaluation and for the best advice.

Published on Jul 11, 2012


Edward Domanskis M.D.

Published on Jun 22, 2017

I would not recommend any of the sutures for the weight tends to be too great, even going down to a very small implant. I make a neo pocket which allows me to amend and correct the problem! It is like starting over! All the things you mention may work, but probably not.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/7193_1500928629.jpg
Answered by Edward Domanskis M.D.

I would not recommend any of the sutures for the weight tends to be too great, even going down to a very small implant. I make a neo pocket which allows me to amend and correct the problem! It is like starting over! All the things you mention may work, but probably not.

Published on Jul 11, 2012


More About Doctor David J. Levens, MD

Published on Jun 22, 2017

Permanent sutures to close off the lower part of the capsule are a very good technique to correct your problem. It is also helpful for the success of your result that you are planning on downsizing your implants as there will be less downward pressure on the repair—less likely that the bottoming out may recur.

Answered by David J. Levens, MD (View Profile)

Permanent sutures to close off the lower part of the capsule are a very good technique to correct your problem. It is also helpful for the success of your result that you are planning on downsizing your implants as there will be less downward pressure on the repair—less likely that the bottoming out may recur.

Published on Jul 11, 2012


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