Best Way to Fix Bottomed out Breast Implant?

I got breast implants on February 26th, so almost 8 weeks. I had concerns about my left breast (when looking at me) from about 4 weeks post op. Today, I went to my PS and the Nurse stated that it looked like it had bottomed out. I am a thin patient )105lbs, 5ft2in. 34A pre-op and did 330cc implant filled to 380cc. My breasts before were very symmetrical though! Dr. said that we will wait at least 6 mths before we decide on anything. He would never say to me bottoming out though. What is best way 2 fix it?

Doctor Answers 12

Fixing bottoming out usually equals capsullorhaphy

“bottoming out”  is the term used to describe the condition which occurs when the breast tends to look as if it has descended on the chest wall after previous surgery,  whether the surgery involved implants, a lift, or a reduction.  In the case of “bottomed out” implants,  sutures can often be placed in the lower pole of the breast to re-elevate the breast on the chest wall.  This is called a capsullorraphy and can achieve excellent tresults in the correction of “bottomed-out implants.

Best Way to Fix Bottomed out Breast Implant?

Best Way to Fix Bottomed out Breast Implant? Wat at 6-9 months and then perform a caspuslorrhaphy. Slight overcorrectionis necessary and support in the post-operative period.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 55 reviews

Revision breast augmentation in Manhattan.


1) "Bottoming out" is a very specific deformity, and you don't have it. You do have significant asymmetry, though.

2) Your right breast looks larger, the right nipple is higher. and the fold under your right breast is lower. I would wait a few months, to make sure things are not changing, and then a revision breast augmentation should make you better.

3) Each revision is individual. Your surgeon needs to make a specific plan for your anatomy.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Fixing bottomed out breasts

It does look as though your breast has bottomed out. It is necessary to heal for 4-6 months so that the tissues are healed and can handle the stitching needed to close off the extra pocket and move the implant back up.

Breast Asymmetry

It is early and I agree with your surgeon about waiting as things may change over the next few months. Your right breast appears a little bigger and the breast fold is lower. Preop photos could tell me if some of this was present before surgery. If needed the fold on the right side can be raised but it is not an easy surgery to perform well and get to last without recurring.

Richard Linderman, MD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 9 reviews

Bottoming out?

You may indeed have some bottoming out on the right breast( in the photo) but it also could be due to some natural asymmetry.  Give it a few more months.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 19 reviews

The bottom is not "out".

 In my opinion the bottoming out is when a significant portion of the implant sits in the lower portion of the breast creating an unaesthetic breast.  Looking at your picture it appears to me that the pockets may have slightly different dimensions producing two different breast shapes.  Both are acceptable individually.  You may need to decide which breast shape you prefer and match the other to that shape.  I would heed the advice of your surgeon to wait. Continue follow up with your surgeon.   There may be some more changes in shape.  

Dr. ES

Bottoming Out and What to Do

It’s not unusual for patients to note implant malposition in the immediate post-operative period. In many cases, this is transient and related to swelling and muscle spasm. For this reason, revisional surgery should be delayed for at least 6 months following surgery. Prior to this time, corrective surgery involves trying to hit a moving target because wound healing is such a dynamic process. At six months, muscle spasm, skin tightening, swelling and inflammation associated with wound healing have improved sufficiently to obtain a good result.
Your right breast implant has drifted downward, but it’s only been two months since your surgery; for this reason, revisional surgery should be delayed for an additional four months. At that time, if the problem is still present, corrective surgery can be undertaken. Correction would require a procedure known as capsuloraphy. This procedure involves placing sutures in the lower breast pocket to raise the height of the inframammary fold. The procedure provides correction of the problem and is associated with high satisfaction rates.
If you’re concerned about implant malposition, it’s important to consult your plastic surgeon. Your surgeon should be able to formulate a plan that addresses your concerns.

Best way to fix bottomed-out breast implant?

Hello! Thank you for your question!  

Given your history as well as symmetry and shape issues, consideration for pocket revision is reasonable.  A capsulorrhaphy would be needed for revision of your breast pocket. If you do need such, the use of a dermal matrix or mesh may be considered if your tissue now has significant laxity that is failing in support or a significant deformity in which recreation of the breast pocket is required along with adding additional support and coverage of the implant.  Certainly, the larger the implant, the heavier the weight...thus, it may be useful to consider placement of a matrix or mesh.  Otherwise, capsulorrhaphy for pocket revision using your native tissue should suffice.  It has been used safely and effectively to correct synmastia, restore the inframammary fold, mask implant issues (e.g., rippling, wrinkling, etc.), support the implant within a "sling", and improve aesthetic results in revisionary breast implant and reconstructive procedures.  However, only by physical examination would one be able to make recommendations on the benefits over the risk of using a matrix or mesh in your situation. 

Consult with a plastic surgeon well-versed in breast procedures who will assist you in deciding which procedure(s) will be the right for you.  Best wishes!  Hope that this helps!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 14 reviews


Thank you for your question. From your picture, this is not technically bottoming out, but you have asymmetry in the positions of your two implants. In particularly the distance from the lower crease of the breast to the nipple differs between sides. This can be due to a stretch deformity of the implant pocket, or drop of the lower breast crease. Capsulorrhaphy, mentioned earlier, is definitely an excellent, option and should be tried first. There are other options, though, if the capsule is not sturdy enough or the problem recurs. One product that has been used for several years is called Strattice and provides scaffold material (derived from acellualrized pig skin) that can be used to help support the implant in a higher position. A newer product, called Seri-Scaffold may be a more palatable option for patients who do not like the thought of pig skin, This product is like a textile, is derived from silk, and can also be used to hold the implant in place. This product is currently being used, in several centers across the USA, to aid in breast revision surgery for stretch deformity or bottoming out.

Terence Michael Myckatyn, MD
Saint Louis Plastic Surgeon
5.0 out of 5 stars 2 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.