Bottoming Out Repair Inferior Capsulorrhaphy

Posted On: June 13, 2012 Author: The Office of Dr. Stuart Linder Posted In: Breast Revision

The patient presents with severe bottoming out of the right breast, requiring reconstructive surgery, including a superior right open capsulectomy, reshaping and opening up the upper pole of her implant pocket, as well as performing an internal inframammary capsulorrhaphy suturing the release capsule approximately 1.25 inches up.  Subsequently, the inframammary skin was then removed, performing an inframammary tightening procedure.  Her preoperative photos show not only disproportionately too large implants for her, but improper positioning of the implant causing raising of the nipple and bottoming out of the implant down approximately 1.25 inches below the left side.

The patient underwent open capsulotomy, removal and replacement with high profile saline implants, inframammary inferior internal capsulorrhaphy and inframammary skin tightening.  Her three-month postoperative photos show good inframammary fold symmetry with the right nipple areolar complex lowered and slightly more symmetric than preoperative.  Patient feels the implants are more appropriate to her shape and the inframammary fold has tightened nicely.

Bottoming out is a severe complication and can be very difficult to repair, especially with thin capsules.  Luckily, this patient has thicker capsule that could be released from the pectoralis major and superior rectus abdominis muscle attachments and acting as a sling to allow the implant to be elevated to regain symmetry.