Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of post-augmentation breast deformity. Reports progressive inferior displacement of the breast parenchyma relative to the implant, resulting in a "bottoming out" appearance. Patient notes dissatisfaction with aesthetic contour, citing loss of superior pole fullness and descent of the nipple-areolar complex (NAC) above the implant position. No history of trauma, infection, or capsular contracture.
Clinical Examination Findings
Physical examination reveals bilateral/unilateral inferior implant malposition. The inframammary fold (IMF) is obliterated or displaced inferiorly. The implant resides below the native IMF, creating a "double bubble" or "bottoming out" contour. Superior pole is flattened with visible implant rippling. NAC position is superior to the point of maximum projection. Skin envelope shows signs of laxity. No evidence of Baker Grade III/IV capsular contracture.
Treatment Protocol
Recommended surgical intervention: Revision mastopexy with internal IMF reconstruction. Procedure involves capsulorrhaphy or suturing of the inferior capsule to the chest wall to re-establish the IMF, potentially combined with implant exchange or repositioning. If significant skin laxity is present, a formal mastopexy (periareolar or Wise-pattern) is indicated to address the NAC position and redundant skin envelope.