Implant malplacement is the second most common reason for revision and bottoming down is the most common presentation of implant
malplacement. Submuscular biplane relocation was combined with capsulotomies and multilayer capsulorrhaphy when bottoming
down was seen following subglandular breast augmentation. Between 2005 and 2009, bottoming down following subglandular mammoplasty
was seen in 41 breasts (19 bilateral and three unilateral). Of the 19 patients, 12 had downward transgression of inframammary
crease (IMC) alone; this also included a patient with vertical scar mastopexy. Two patients had multiplane malplacements where
bottoming down was associated with lateral displacement (telemastia) in one and medial displacement (symmastia) in the other.
Two had simultaneous downward transgression of the IMC and nipple areolar complex (NAC) and three had bottoming down with
capsular contracture independent of NAC descent. Follow-up of up to 3 1/2 years showed stable IMC and NAC relationship with
acceptable results. Dog ear revision was required in one patient when IMC relocation was accompanied with vertical scar mastopexy
and one patient needed revision for further relocation and improvement of symmastia. No wound breakdown or periprosthetic
infection was seen in their series. Multilayer capsulorrhaphy with submuscular biplane repositioning of implants is a suitable
option to correct bottoming down following subglandular augmentation.
Keywords Capsulorrhaphy - Muscle-splitting biplane technique - Symmastia - Bottoming down
This study was presented at the Oral Presentation, Aesthetic Surgery of Breast, 13th Annual Conference, Pakistan Association
of Plastic Surgeons, 28–30 March 2008.