Revision Surgery for Bottoming Out? A Complete Guide by Incision — Armpit vs. Inframammary Fold (Advice from 20 Years of Research)
Hello — we are U&U Plastic Surgery, and we perform no cosmetic surgery other than breast surgery.
Before this article, we wrote a column explaining bottoming out and lateral displacement for first-surgery patients.
Today, we will write a column for those in whom bottoming out has occurred after surgery.
So if you are preparing for your first surgery, please read the articles below instead.
Bottoming Out: Causes and Prevention, Based on 20 Years of Research Experience
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Lateral Displacement? These Post-Surgery Cases May Require Revision Surgery
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Because of the bottoming out,
it shows every time I get dressed —
I can hardly stand looking in the mirror.
I've thought about just having
the implants removed,
but that feels like a waste.
And even if I correct the bottoming out,
I'm worried it will just recur later.
Source
Some of you reading this may be wondering whether surgical correction is really necessary.
But when bottoming out occurs, revision surgery is usually needed to correct it.
Since the complication stems from the implant position itself dropping, repositioning the implant without surgery would be difficult.
So today we will cover two topics:
1. Revision surgery methods for bottoming out
2. For those worried about bottoming out recurring after revision surgery
Source
This advice comes from 20 years of research experience, so please be sure to read it.
1. Revision surgery methods for bottoming out
Source
Whether performed through the armpit or through the inframammary fold, the principle of bottoming-out revision surgery is:
use the existing capsule to build
a strong lower capsule.
Source
With the armpit approach, however, there can be limits to how firmly the fold can be fixed.
- If the bottoming out is mild and a small implant was used, correction may be possible through the armpit using electrocautery, fold-pinching sutures, and similar techniques.
But if the bottoming out is severe and the implant is large, armpit-based correction can be difficult. In such cases, revision surgery may proceed through an inframammary fold incision instead.
Operating through the inframammary fold allows much stronger fixation of the fold.
One such technique is 'anterior-posterior capsule suturing.'
Visually, anterior-posterior capsule suturing looks like the image below.
It is a method of stitching together the lower portions of the capsule that descended along with the implant.
This surgery must be performed with the capsule in direct view, which is why it is difficult through the armpit.
If your first surgery was through the armpit, you may be weighing the thought of a scar in yet another location.
But because this approach holds far more firmly than an armpit revision, we recommend it when bottoming out is severe.
Participated in the 2024 Seoul National University symposium
2. For those worried about bottoming out recurring after revision surgery
Source
Let us describe the most powerful method of fixing the fold.
It is performed through an inframammary fold incision, and the technique is called shortening capsulorrhaphy.
How the capsule is fixed is shown in the video below.
You can think of it as sweeping the implant's capsule entirely to one side and rolling it up.
This leaves part of the implant in contact with raw tissue, without capsule in between. Direct tissue contact lets it adhere better, preventing bottoming out.
This surgery, however, is quite demanding.
In the process of sweeping and rolling the capsule to one side, the ribs and intercostal muscles can be disturbed.
So we recommend deciding on this surgery only after a thorough consultation with your surgeon.
For those researching revision surgery for bottoming out, that is everything we have prepared.
If you would like to review today's material again, please watch the video below.
For those curious about revision timing, pain, cost, and more, we also attach helpful columns.
Breast Revision Surgery: Timing, Pain, Recovery? Advice Based on 20 Years of Research
Hello — we are U&U Plastic Surgery, founded on over 20 years of breast surgery resear…
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Breast Revision Cost: Why Does It Vary So Wildly by Review and by Clinic? <Advice from 20 Years of Research>
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We have organized revision outcomes based on a range of research findings, so please take a look.
Among those reading this far, some may find it hard to decide on a visit, having not set foot in a plastic surgery clinic for years.
For those readers, we close by sharing a resource of things to consider before a consultation.
[Free PDF]
A collection of breast surgery Q&As
from 2 years in mom-community forums
Source
For 2 years, we ran a Q&A on breast augmentation in mom-community forums.
We answered questions about complications such as capsular contracture, as well as questions from those weighing important life stages such as childbirth and pregnancy.
Hoping to help those interested in breast augmentation, we share a selection of the most frequently asked questions from the Q&A.
[Free PDF] A collection of breast surgery Q&As from 2 years in mom-community forums
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U&U Plastic Surgery currently keeps to a principle of 3 surgeries / 6 consultations per surgeon per day.
If you would like a consultation with us, please book through Naver Booking via the map below.
That is everything we have prepared.
Thank you for reading this long article.
This has been U&U Plastic Surgery — a breast surgery clinic born of 20 years of research devoted to the breast.
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U&U Plastic Surgery Clinic
Myungkwang Building, 819 Nonhyeon-ro, Gangnam-gu, Seoul