Breast revision

Front & SideBottoming Out

Breast revision — what is the problem?

Choosing the right surgery for the cause matters more than anything.

Bottoming Out
Size dissatisfaction
Upper bulge
Shape deformation
Capsular contracture
Implant rupture
Lateral displacement
Rippling
Asymmetry
Symmastia

21 years of know-how, Dr. Kim Ki-kap, M.D., Ph.D. (SNU)

“Chief director Kim Ki-kap operates in person.”

Plastic surgeon / M.D., Ph.D.

Kim Ki-kapChief director

· Seoul National University College of Medicine · SNU Graduate School — M.S., Ph.D. · Plastic surgeon, SNU Hospital · University of Chicago, plastic surgery fellowship · Baylor College of Medicine, plastic surgery fellowship

Chief director Kim Ki-kap, U&U Plastic Surgery Clinic

*To focus on high-difficulty surgeries, Dr. Kim Ki-kap does not perform simple augmentations — thank you for understanding.

Bottoming-out breast revision — what is it?

Side view of a breast with bottoming out — the inframammary fold has dropped

The implant descends below the expected inframammary fold

Symptoms: The nipple-to-fold distance grows longer and the nipples start pointing upward.
Causes: The inframammary fold was not fixed properly, or the upper pocket was under-dissected while the lower pocket was over-dissected

Precise dissection and a firmly fixed fold!

How bottoming out is corrected

Diagram showing the location of the inframammary fold incision

Inframammary fold approach

If bottoming out is mild, the fold can be corrected by pinching it in with sutures, like buried-suture eyelid surgery — no incision, so recovery is relatively fast. If severe, electrocautery is used with anterior-posterior capsulorrhaphy and capsule-shortening fixation.

Diagram showing the location of the axillary incision

Transaxillary approach

If the first surgery used an axillary incision, electrocautery can shrink the capsule. Replace the implant with a lighter one, and set the fold slightly higher to allow for skin sagging over time.

U&U's core technique

Preventing bottoming out

Covidien V-Loc 90 absorbable wound closure device package and suture — V-loc sutures

Ethicon Stratafix 2-0 suture package and suture — Stratafix

To prevent bottoming out the fold must be firmly fixed: U&U double-locks it with Johnson & Johnson's Stratafix and Covidien's V-loc sutures.

U&U's bottoming-out solution

U&U capsuloplasty techniques

The front and rear capsule are tied firmly at the fold

Anterior-posterior capsulorrhaphy

Firmly tying the anterior and posterior capsule at the implant fold

The stretched capsule is pulled up and fixed

Capsule-shortening fixation

Pulling up the capsule stretched below the fold, shortening it and fixing it in place

*Symmastia and lateral-displacement cases can also be resolved with capsuloplasty on the same principle.

Accurate diagnosis by an experienced surgeon

U&U revision cases

The key to fold correction is handling the capsule that has formed and descended. Bottoming out calls for precise dissection and the skill to fix the fold firmly.

Before-and-after comparison of bottoming-out revision — Before / After 2 weeks (front and side) — Her 4th revision — after bottoming out from surgery at another clinic

Before-and-after comparison of symmastia (front displacement) and bottoming-out revision — Before / After 2 months (front and side) — Symmastia (front displacement) with bottoming out

Before-and-after comparison of revision for asymmetry caused by bottoming out — Before / After 3 weeks (front and side) — Asymmetric breasts caused by bottoming out

These photos are posted with the patient's consent.

Dr. Kim Ki-kap, U&U Plastic Surgery

Medical advisory

Press column page — “How to resolve bottoming out and other complications after breast surgery.” Dr. Kim Ki-kap advised: “Before breast surgery, check that your surgeon has ample knowledge and experience in the field; after surgery it is important that patients themselves check regularly for complications and abnormal symptoms.”

Breast revision

The difference in precision is the difference in results

Q. What habits help after breast surgery?

· Wearing a firm bra with cups that keep the skin from stretching and sagging helps prevent bottoming out and breast sagging.

· Regular back-muscle workouts let your back support the weight at the front of the chest.

· Push-ups and pull-ups keep the implant's weight from pulling the chest forward and straighten the shoulders — easing stiff shoulders and neck strain for a healthier, better posture.

Q. How do I prevent bottoming out after surgery?

After breast surgery, wear firm-cup underwear to prevent gravity-driven bottoming out and sagging, and attend follow-up visits and regular checkups for a set period to monitor for complications or abnormal symptoms.

Breast surgery:

why U&U stands alone!

Point.01

One-stop in-house testing

U&U performs pre-op general anesthesia tests and breast cancer screening all in-house.

Blood sample testing and ECG testing — Blood test and ECG as standard!

Mammography reading image and mammography equipment — Chest X-ray and mammography

Breast ultrasound equipment and Mammotome equipment — Breast screening and Mammotome too

Point.02

Private recovery & waiting rooms

Corridor of the private single recovery rooms

U&U in-clinic nurses' station and waiting room

Recover or wait comfortably in a private space.

Rigorous safety system

Max 3 surgeries per day

· Accounting for surgeon fatigue and operating time
· We focus entirely on you

Dual CCTV available for review

· The entire procedure recorded as-is, from start to closure
· Safe surgery with no worry of substitute surgeons

Safe anesthesia system

· Board-certified anesthesiologist always on site
· 1:1 monitoring dedicated to breast patients only

UPS backup generator with emergency drugs and equipment

Safe even in emergencies

UPS backup power, dantrolene, Avagard, pain-control devices, patient warmers and more — equipment ready for a wide range of situations

A phone showing the Emergency CALL screen

Triple emergency-call system

Three emergency-call numbers for emergency response (010-xxxx-xxxx) (010-xxxx-xxxx) (010-xxxx-xxxx)

Point.03

Aftercare that sets U&U apart

Premium aftercare

Heat-lamp massage
U&U care pouch
Capsulitis care
RF or ultrasound
Healite
Scar laser

A good surgical result is not the end.

Even more precious after surgery — U&U aftercare

Have you seen aftercare like this?

Physical Therapy after breast surgery

· Custom-made equipment (fitted to implants)
· Licensed female physical therapists
· 1:1 sessions in a private treatment room

Pain care: Physical & manual therapy
Exercise: Prop exercises, rehab stretching
Habits: Correcting poor posture and habits

Pilates after breast surgery

· Licensed female Pilates instructors
· Curriculum matched to breast recovery
· Relieves swelling, pulling and knotting
· Less pain in the neck and shoulders
· Better motor sense of nerves and muscles

* Patients from other clinics may also use follow-up care *

For your safety —
breast screening is a must!

Why do pre- and post-op breast screenings matter?

Pre-op

· Current breast condition
Check for disease, etc.
· Assess need for biopsy
Can be done in-house right away if needed
· Check overall contour and asymmetry
Choose the right method and implant based on results

Post-op

· Check implant seating and any rupture
· Check for seroma, hematoma and surgical status

Testing / diagnosis / treatment at once!

Ultrasound
Mammography
Biopsy
Mammotome

U&U offers hospital-grade equipment and expert staff.

Seoul National University Hospital Breast-surgery subspecialist

Lim Chang-jinDirector

U&U Plastic Surgery

LOCATION

3F Myeonggwang Bldg, 819 Nonhyeon-ro, Gangnam-gu, Seoul (Sinsa-dong 586)

5-min walk from Apgujeong Stn (Line 3) Exit 4

Ground-level valet parking available

Map to U&U Plastic Surgery Clinic — Garosu-gil, near Apgujeong and Sinsa stations

Naver Map

Hours

Mon–Thu: 10:00 AM ~ 07:00 PM
Friday: 10:00 AM ~ 09:00 PM
Saturday: 10:00 AM ~ 04:00 PM