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- Double Board Certified by the American Board of Plastic Surgery and the American Board of Surgery
- Fellow, American College of Surgeons
- Member, American Society of Plastic Surgeons
- Member, American Society for Aesthetic Plastic Surgery
- Member, American Medical Association
- Named among “America’s Top Surgeons”
- Voted “Best Plastic Surgeon” and “Best Physician” in Fort Lauderdale
Internal Bra Technique for Bottoming Out, Double Bubble and Synmastia Repair
Correcting Improper Positioning of Breast Implants
What is bottoming out?
Bottoming out is a specific example of a post-operative problem requiring a thorough, systematic approach and innovative surgical techniques. Dr. Revis has seen a dramatic increase in the number of patients presenting from other offices and other countries with bottoming out of one or both implants. This is the most common revision that Dr. Revis performs, usually ten to fifteen times a week, thanks to his trademarked technique the Internal Bra.
Photos Show a Repair
Intraoperative photos show a repair of severe bottoming out and lateral displacement of both breasts using the Internal Bra procedure. The right breast has been repaired, and now the left breast will be repaired.
32 year old with Bottoming Out and a Wide Gap
Photos show a 32 year old out of state patient with bottoming out and a wide gap, at pre-op and six weeks post-op. An Internal Bra procedure was performed, along with an implant exchange from 275cc moderate plus profile silicone gel to 325cc moderate plus profile silicone gel.
Bottoming out is present when one or both implants
Bottoming out is present when one or both implants are positioned too low or too lateral on the chest wall in relation to the nipple position. This means that the pocket, or capsule, surrounding the implant has become too low on the chest wall (bottoming out) or rests too far laterally when lying down (also referred to as lateral displacement).
This May Represent Overdissection
This may represent overdissection of the pocket in the region of the inframammary crease during surgery, cutting of the lower portion of the pectoralis muscle, or may occur naturally over time and under the effects of gravity in patients with implants that are placed above the muscle or only subpectorally (partially submuscular) when compared to total submuscular placement of breast implants.
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What is double bubble?
Double bubble (shown below) is present when there is a groove along the breast below the nipple giving the appearance of the breast sitting on top of the implant. This is often observed in patients with bottoming out. The groove represents the old inframammary crease that has actually lifted off of the chest wall and allowed the implant to slip out from underneath the breast.
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What are the symptoms of bottoming out?
Most patients report that they have a hanging or heavy sensation because of lack of support for the implant. This may also progress from mild discomfort to real pain. Rippling may be present as well because of the thinned tissues along the bottom of the breast.
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How is bottoming out diagnosed?
Seek a qualified physician
Bottoming out is usually diagnosed by the patient or by a plastic surgeon. An experienced plastic surgeon should be able to diagnose bottoming out from photos alone.
Look For Signs
When diagnosing yourself, in addition to the heavy or uncomfortable feeling, you may also notice a worsening of your implant position in relation to your nipple position. This may cause the appearance to be unattractive and even uncomfortable when wearing no bra. Because the implants hang too low, you may not be comfortable going braless. You may need to wear a pushup bra to correctly position your implants or to keep them from falling far apart and even into your armpits when lying down.
Look for Proper Position
Proper implant position means that the nipple is centered on the center of the breast implant. If more of the implant rests below the nipple than above the nipple, then you have bottoming out.
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Can bottoming out be corrected non-surgically?
Bottoming out cannot be corrected non-surgically, but must be repaired using the Internal bra. Bottoming out is a progressive disorder that generally gets worse over time as the effects of gravity cause the implant to sag within the tissue envelope of the breast. The heavy or uncomfortable nagging feeling may worsen to sharp pain with progression of the bottoming out.
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Will switching to smaller implants correct bottoming out?
Switching to smaller implants alone will not correct bottoming out. The new implants will still sink to the bottom of the pocket, taking even more volume away from the upper pole fullness. In my experience the only true, long term correction for bottoming out is the Internal Bra procedure.
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How can bottoming out be corrected?
To correct bottoming out, Dr. Revis performs the Internal Bra procedure. Using special lighted retractors, Dr. Revis expands the implant pockets (capsulotomy) superiorly and medially, creating room for the implants to be repositioned at a higher level, creating better cleavage, a more youthful shape, and improved fullness in the upper pole of the breast.
The Dr Revis Method
Dr. Revis then closes part of the pocket that rests laterally and inferiorly, thus preventing the implants from resting too low or falling too laterally to the sides. Dr. Revis uses permanent sutures for a long-lasting result. These sutures are carefully placed so that the suture material is never in direct contact with the implants inside the body.
Example of Bottoming Out & Rippling
Photos show a 26 year old international patient with bottoming out and rippling, at pre-op and twelve weeks post-op. An Internal Bra procedure was performed and Strattice placed bilaterally, in addition to an implant exchange from 700cc high profile silicone gel to 800cc ultra high profile silicone gel.
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How Long Will The Internal Bra Last?
With Dr. Revis’ technique, he has found that after the Internal Bra is fully healed (around 12 weeks), it usually lasts for many, many years. This truly anatomical correction places the tissues back in their proper orientation, the way the body was designed. The patient below is one example of an excellent ten year long term result.
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May I switch to larger implants when I have my bottoming out corrected?
Absolutely. Approximately 30% of patients who undergo the Internal Bra procedure keep the same size implants, 60% increase the size of their implants, and the remaining 10% reduce the size of their implants. The size/weight of the implants has no relationship to the success or the long-lasting nature of the bottoming out correction with the Internal Bra technique when it is performed correctly with permanent sutures.
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What is synmastia?
Synmastia (shown below) is present when one or both implants are positioned too close to the midline over the breastbone (sternum). This means that the pockets, or capsules, surrounding the implants are too medially placed.
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May I see examples of the Internal Bra procedure?
Please click the links below to review pre- and post-operative photos of the Internal Bra procedure, as well as numerous examples of other breast implant problems.
Call 954-630-2009 to schedule your consultation
Internal Bra Before & After Photos
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