In some cases, the breast implants move downward as the tissue that supports the device becomes weak and lax.  If this happens, the breast crease will settle lower on the chest, leading to a cosmetically displeasing result.

Fortunately, there are several ways to prevent this problem and one of the most effective is choosing the right implant size.  For instance, petite women who often have a limited breast tissue and skin are generally recommended to choose smaller sizes in order to prevent bottoming out; in this way, they can also avoid visible and palpable ripples in the shell.

It is important to remember that inordinately large implants can expose patients to a higher risk of bottoming out and premature breast ptosis (or sagging) because of the extra weight the tissue and skin has to carry.

Another way to avoid bottoming out is creating an implant “pocket” which should be in the right size, preventing gross movements of the device.  But in case that the room for implants has been over-dissected, the problem will usually occur just several weeks or months after a breast augmentation.

Meanwhile, the right placement of implant, particularly the complete submuscular technique, can also minimize the risk of bottoming out since the breast implants are supported by a thicker amount of tissue in the lower poles.  This is not the case in other implant placements in which the lower poles are only supported by the skin tissue.

Another advantage of complete submuscular or “unders” is it prevents visible and palpable rippling because the top two-thirds of the implants is covered by the pectoral muscle.

Some doctors also suggest that using a bra that provides a good support to the weight of the implants can prevent or at least minimize the risk of bottoming out and breast ptosis.

But in case the implants have bottomed out, the only way to treat this problem is through another surgery which often involves an incision made along the breast crease.  In this way, doctors can cut and roll up the tissue surrounding the device and then secure it with internal sutures.

Once the implant “pocket” has been corrected, the incision site is closed with tiny sutures.

For some patients, they may be asked to downsize their breast implants particularly if the main reason for bottoming out is the excess weight of the large implants.

These are the most common breast problems and their corresponding solution, according to LA plastic surgeons:

• Drooping breasts

Due to aging, pregnancy, and major weight loss, some women develop drooping breasts with nipples pointing downwards.  To treat this problem, plastic surgery experts use breast lift which involves removing the excess skin, manipulating the underlying muscles, and raising the bust to a higher position.  In some cases, they complement this surgery with implants to further make the breast, particularly the upper pole, appear fuller.

• “Swooping” breasts

While the breasts do not have a pronounced droopiness, they bend inward above the areola resulting to a “swooping” appearance.  To treat this aesthetic problem, plastic surgeons use breast implant surgery to improve the contour of the bust.

• Smaller breasts

Due to genetic predisposition, some women have extremely small breasts almost comparable to men’s.  Fortunately, breast augmentation through the use of saline or silicone implants can increase their bust size.

For women who do not want to use synthetic materials to increase their breast size, they can opt for fat grafting, a procedure in which doctors collect fats from their tummy (or areas where fats tend to accumulate), which are purified to separate the blood and tissue and then re-injected to the breasts.

However, fat grafting can only increase the breast with less than a cup, which means that it is not ideal for women who want to significantly augment their bust.

• Tuberous-shaped breasts

In this problem, the breasts have a prominent outward projection from the chest wall and are very narrow at the base, thus resulting to a tubular shape.  This condition usually happens on women who have small breasts with noticeable droopiness due to skin and tissue laxity.

In LA plastic surgery, most doctors treat this problem through breast implant surgery that is usually combined with breast lift especially for women with extremely sagging bust.

• Enlarged areola

In some cases, women who need breast lift or breast reduction will also benefit from areola reduction surgery to further create a more natural-looking appearance.  Fortunately, combining this procedure with other breast surgeries does not require additional incisions because they usually have the same surgical site.

As with any plastic surgery, breast lift comes with risks such as unnecessary scarring, delayed healing, infection, and excessive bleeding.  For this reason, patients should be physically fit and have a normally functioning immune system.

Aside from being healthy, the right candidates for this plastic surgery should have realistic expectations and goals which will most likely determine if they are going to be satisfied with the result or not.  With this, plastic surgeons always conduct consultation and interview with their patients before proceeding with the operation.

During the consultation period, doctors will explain to their patients that the procedure will not significantly change the shape of the breasts and will not permanently make them firm.  For this reason, women should consider that they may need a revision plastic surgery at some point in their lives to contour the effects of aging.

For women who are considering having children in the future, some plastic surgeons may recommend that they postpone breast lift.  This is because pregnancy and breastfeeding may stretch and weaken the skin and tissue, thus affecting the result of the surgery.

To reduce the risk of infection, delayed healing, and skin necrosis (death of skin tissue), doctors require their patients to quit smoking several months before their operation and during their recovery.  According to several studies, the nicotine constricts the blood vessels which prevents the oxygen from effectively reaching the wound, as a result, smokers are more likely to experience delayed healing which may even lead to skin necrosis and unnecessary scarring.

Meanwhile, breast lift is traditionally performed using the anchor-shaped incision that resembles a nautical anchor—a circular cut around the areola, another one starting from the nipple down to the breast crease, and one more that covers the fold of the bust.

In general, this approach is recommended for women who have larger breasts with severe droopiness.

Because of the extensiveness of the anchor-shaped incision, this technique is usually not ideal for small- to medium-breasted women and those who with minimal to moderate sagginess.  For this reason, surgeons have developed modified breast lift procedures which usually require fewer incisions, less scarring, shorter downtime, and reduced risk of complications.

When it comes to giving a natural result and feel, most plastic surgeons agree that the silicone are slightly better than the saline implants because of the cohesive gel that exhibits “shape memory” which means that it goes to its original form.

However, the cohesive gel does not easily dissipate around the tissue in case of a leak, as a result, the problem may go undetected for years and may predispose patients to complications such as hardening of the breast, pain, and infection.  For this reason, plastic surgeons oblige women to undergo MRI screening three years after their surgery and every two years from then on.

The MRI screening is not necessary for women with saline-filled implants because a leak will immediately provide visible manifestations such as deflated-looking breasts just four hours after the shell ruptures, according to plastic surgeons.  With this, patients can immediately seek a revision plastic surgery to correct the problem.

Both the saline and silicone implants come in smooth or textured outer shell.  The smooth implants move freely inside their pockets (which means less likely to ripple) and usually provide a more natural feel, while the textured version is said to lower the risk of capsular contracture, although this claim has not yet been proven.

Capsular contracture is a painful condition in which the tissue attaches itself around the implants, resulting to a hardened, ball-shaped breast.

According to plastic surgery specialists, both the saline and silicone implants come in two shapes.  The round implant is said to provide a fuller appearance especially in the upper poles, making this ideal for patients who want to achieve a good cleavage, while the teardrop implant gives a more natural “slope” in the bust.

Because of the symmetrical shape of the round implants, they can move freely without distorting the appearance of the breast.  This is not the case in teardrop implants which may “flip over” and disfigure the bust, for this reason, they only come with a textured outer shell.

It is important to note that breast implants do not last forever, although many patients can have these biocompatible materials for 25 years without experiencing any problem.  Meanwhile, the Institute of Medicine has estimated that breast implants last an average of 16 years.

For drooping breasts with nipples pointing downwards, doctors in plastic surgery use mastopexy or what is more commonly referred as breast lift.  In this procedure, they usually create incisions around the areola, across the crease of the breast, and vertically from the areola to the fold that will allow them to remove the excess skin, raise the bust to a higher position, and reshape the tissue.

In certain cases, this approach is too invasive for some women, particularly those with smaller breasts that have minimal to moderate sagginess.  For this reason, plastic surgeons use modified breast lift techniques which remove the horizontal incision across the breast fold or even the vertical cut.

While breast lift can raise the bust, it does not create fullness in the upper poles.  With this, some women ask for a breast implant surgery to complement the procedure, especially those who want to achieve a more prominent cleavage.

For women who have “swooping breasts” (they bend inward above the areola) and those with “tuberous” breasts (they have a very narrow base and have a prominent projection), most experts in plastic surgery agree that breast implant surgery is usually the best approach to address these aesthetic problems.  If needed, the implant surgery is complemented with breast lift to further improve the contour.

But still, breast implant is more popular known as a way to increase the size of smaller breasts.  To date, most plastic surgeons prefer using silicone or saline implants due to their high tissue compatibility and relative safety to a significant number of patients.

While there are many women wanting to have larger breasts, some big-busted individuals would like to reduce their size to eliminate the physical symptoms associated with extremely large breasts which usually include bad posture, difficulty to engage in sports and rigorous activities, bad posture, and chronic pain in the shoulder, neck, and back.

To reduce the size of large breasts, doctors in LA plastic surgery perform reduction mammaplasty which involves the same incision sites used in the anchor incision breast lift.  If necessary, they complement this procedure with liposuction to remove the excess fats in the bust.

In some cases, reduction mammaplasty involves minimizing the size of an enlarged areola and repositioning this to a higher position.

Many patients who had this plastic surgery said that the recovery period is the most challenging for them rather than the procedure itself.  This is because they had to endure pain and discomfort, nausea, swelling, and bruising especially within the first few days of their operation.

Despite the discomfort, most plastic surgeons require their patients to start walking as soon as possible to promote better blood flow and faster healing, and prevent excessive swelling and blood clotting.  Meanwhile, people should not lie down all the time as doing so can aggravate swelling, slow down their metabolism, and predispose them to risk of blood clotting in the legs, lungs, and other vital organs.  (See picture below.)

In some cases, plastic surgeons also require their patients to perform breast massage and compression exercises that involve pushing the implants to the outermost corners of the pockets.  If performed correctly, this post-operative care can provide a more natural appearance by promoting the synthetic materials to “settle” down to their proper position.

Aside from providing a better result, breast massage has also been said to reduce the risk of capsular contracture, a painful condition in which the scar tissue attaches itself around the implants, resulting to a ball-shaped bust.

However, not all plastic surgery specialists recommend this exercise especially for women with textured or teardrop-shaped implants.  To be on the safe side, patients should ask their doctors if it is safe to perform breast massage and what is the proper way to do this procedure.

Meanwhile, mammograms (breast X-rays) and examinations are also an important part of implant maintenance program.  According to plastic surgeons, women with silicone-filled implants should undergo MRI screening three years following their plastic surgery and then every two years to detect if there is any leak or rupture in the shell.

For women with saline-filled implants, MRI screening is not a requirement since an implant leak will always have “visible manifestations” such as asymmetrical or deflated-looking breasts.

But to be on the safe side, women older than 40 should undergo an annual clinical breast exam while those who are in their 20s and 30s should at least have this procedure every three years.

Women with implants should also inform their doctors, including their dentists, that they had breast augmentation procedure.  In this way, they may be advised to pre-medicate with antibiotics before they will have surgery or dental work.

Traditionally, plastic surgeons perform breast lift by using anchor-shaped incision that involves a surgical cut around the areola, another one that starts from the nipple to the crease of the breasts, and a third one that is made across the breast fold.

While the anchor incision provides the most dramatic result, most doctors in LA plastic surgery find this too extensive for women who have small- to medium-sized breasts with mild to moderate sagginess.  For this reason, they have started using a modified breast lift called lollipop incision technique.

As the name suggests, the lollipop incision resembles a candy on a stick as it uses a circular incision around the areola and another one that starts from the nipple down to the breast crease.  And since it removes the horizontal incision,—the site that takes the longest time to heal—patients can expect shorter recovery and fewer scars.

According to LA plastic surgeons, this breast lift technique is used specifically for medium breasted patients with moderate to severe sagginess or large breasted women with mild to moderate droopiness.  Generally, this approach is not adequate to treat large breasts that extremely sag, and also too extensive for patients with smaller bust or less noticeable drooping breasts.

As with any plastic surgery, breast lift involves complications and risks, although these can be greatly reduced by choosing a board-certified surgeon and following all the pre- and post-operative instructions such as avoiding certain medications and supplements and quitting smoking.

It is important for patients to avoid aspirin, herbal supplements, and certain anti-inflammatory drugs which can increase bleeding.  To be on the safe side, they should inform their  plastic surgeons about their previous and current medications, previous surgeries, and medical history.

For smokers, they should quit the habit several months before and after their breast lift since the nicotine has been found to constrict the blood vessels, preventing the oxygen from effectively reaching the wound.  If this happens, patients can experience delayed recovery and higher risk of skin necrosis that may lead to unnecessary scarring, according to experts in plastic surgery.

While all women have a degree of breast asymmetry, some have a very noticeable condition especially if the difference in size is a half-cup or more.  For example, a woman has a B-cup on her left breast while the other is a D-cup, or the other one is droopier than the other resulting to “unbalanced” figure.  (The picture shown is an example of unbalanced breasts in terms of size.)

Fortunately, there are different plastic surgery procedures which can create balance between the breasts.  The most common examples of these are breast augmentation through the use of implants, breast lift, and breast reduction.

While these procedures are commonly viewed as a cosmetic surgery, many plastic surgeons believe that these treatments have a positive impact to their patients’ self-esteem and sexuality.  This is proven by a 2006 study involving 35 patients who said that their mental health and self-esteem have improved six months after undergoing a plastic surgery that has corrected their asymmetrical breasts.

• Breast Augmentation

While this procedure is commonly performed to increase the bust size, this is also used to make the breasts more symmetrical if one of them is larger than the other.  This can be done by inserting the saline or silicone implants inside the breast pocket and placing these materials under or behind the muscles.

The saline and silicone implants are the only materials approved by the US Food and Drug Administration (FDA) due to their relative safety to a significant number of patients.

• Breast Lift

This plastic surgery procedure corrects the sagging, pendulous breasts which have lost their skin elasticity and firmness of the tissues.  In most cases, this treatment is commonly performed among older patients and women who had several pregnancies.

While breast lift surgery alone can create a significant improvement, some doctors complement the procedure with breast implant to further make the breast appear fuller and rounder.

• Breast Reduction

In this procedure, plastic surgeons create several incisions which usually include around the edge of the areola, below the breast crease, and a cut which starts from the areola to the breast fold to remove the excess glandular tissues and skin and manipulate the underlying muscles.

Aside from reducing the size of an abnormally large breast, this plastic surgery procedure can also treat the symptoms of this condition including chronic back and neck pain, inability to engage in physical activities, bad posture, and non-healing skin irritation in the breast crease.

Implant deflation is one of the most common reasons for revision breast surgery.  In this condition, the shell breaks and the filling (silicone or saline) leaks out of the implants.  If the saline-filled implant leaks, the bust will immediately appear deflated as the saltwater is absorbed by the surrounding tissue.  On the other hand, a rupture in a silicone-filled implant may not be noticeable since the cohesive gel material stays around the tissue, thus predisposing patients to risks associated with “silent leak” (painful breasts, infection, and silicone traveling to other parts of the body).

Because a leak in a silicone implant may go undetected for years, plastic surgeons generally require MRI screening three years following the implant surgery and then every two years.  However, this is not a requirement for women with saline implants since a leak will usually provide visible manifestations (e.g., deflated or asymmetrical breasts) just four hours after the shell breaks.

In case the implants leak or deflate, the problem can be corrected through revision breast implant surgery.  Fortunately, most US manufacturers provide lifetime warranty for their products, although patients will generally cover the cost of the surgery itself.

In most cases, the revision plastic surgery is performed by removing the damaged implants and replacing them with a new one (the same or different size).

Sometimes, plastic surgeons performed additional procedure in conjunction with the revision breast implant especially if the breasts have changed due to pregnancy, weight loss, and aging.  For example, some patients may benefit with breast lift performed as a complementary procedure for their implant surgery; in this way, the will not just achieve a bigger bust size but also fullness especially in the upper poles.

Aside from implant deflation, other reasons of revision plastic surgery include: implants that shifted in a position resulting to asymmetrical look, tightening of the scar tissue around the implants (or capsular contracture), going too large or too small, natural changes in the breasts due to aging and other factors, and patients unsatisfied with the result.

Meanwhile, some women ask their plastic surgeons to permanently remove their implants due to personal or health reasons.  However, they will most likely need an extensive surgery since the implants have already stretched their skin and tissue.

This procedure, which is popular in California plastic surgery, is also used to lift a slightly sagging breast caused by hereditary predisposition, tissue laxity, pregnancy, and aging.  But still, implant surgery is not the right option for women who have severely drooping breasts as it may even aggravate the problem.

To treat the slight sagginess of the breasts and even postpone its occurrence, plastic surgeons place the implants under the chest muscle rather than over it.  In this way, more tissues and skin can serve as a natural “support” that will prevent the implants from going downward.

In some cases, plastic surgeons complement implants with breast lift surgery to raise a moderately to severely sagging bust which usually has a nipple pointing downward.  In this way, the breast will not just appear firmer but also fuller particularly on the upper poles.

In California plastic surgery, doctors also use breast implants to reconstruct the bust after mastectomy which is the surgical removal of cancerous tumors or in severe cases, even the entire breast.

If the mastectomy involves more tissues and skin, plastic surgeons usually use tissue expander to sufficiently stretch the skin which will then create enough room for the implants.  In most cases, this balloon-like device is placed under the muscle and is injected with saline solution at weekly intervals through a small valve located on a patient’s skin.

After creating enough room, the tissue expander is replaced with breast implants.  And if necessary,  plastic surgery specialists will also reconstruct the nipple and areola to further make the breasts appear more normal.

In most cases, the entire process of breast reconstruction through the use of implants takes six to eight weeks to complete.

While women have different reasons for breast implant surgery, it is important that their body’s anatomy should be greatly considered.  For example, petite women who usually have limited glandular skin and tissue are not a good candidate for extremely large implants because these may lead to greater risk of rippling and wrinkling.