Does Breast Implant Profile Matter in Preventing Bottom Out?

I am 28, 5'8", weighing 136 lbs, with smooth Saline Breast implants (425cc each), under the muscle. I went from a 36A to 36C. I am facing revision 10yrs later. My left breast is bottoming out about 1/2inch. I am going with the memory gel implant, under the muscle with a repair to the left. My surgeon wants to go slightly larger to push me to a small D cup to add volume and close the gap/add cleavage.

Does the profile matter? Would I be able to get a high profile implant with less CC to get the same affect? I want to do everything I can to avoid another bottoming out!

Doctor Answers (12)

Breast implant profile and preventing bottom out

+4

Dear Ms. K28,

I agree with the comments by Drs. Rand and Yuan.

Bottoming out is a multifactorial loss of breast tissue integrity leading to progressive sagging. As we age, our tissues stop repairing themselves as well and the damage becomes visible. Larger implants are heavier and as a result they gravitationally stretch the breast skin envelope , especially its inferior poles, AND cause progressive dropping of the breasts along with pressure wasting (atrophy) of the overlying breast tissues (which adds greater visibility and palpability of the underlying implant shell and its folds.

Personally, I would recommend the smallest implant you can accept - silicone gel if you are inclined with a repair of the lower breast shelf to reef it up and try to prevent further drooping. "Going larger" makes no sense as all it does is kick the can further down the road, forcing your surgeon or another to deal with a much droopier breast with less breast cover later on. Not a good option, in my opinion.

I hope this was helpful.


Memphis Plastic Surgeon
5.0 out of 5 stars 66 reviews

Breast Implant style and bottoming out

+2

Implant size, not implant style, may have more to do with bottoming out in your case. Once the inframammary fold is repaired or reset, a smaller (and therefore lighter) implant will help prevent this problem from recurring in the future. The difference between high profile and moderate plus profile is a matter of millimeters. The most important treatment here is the surgical repair of the fold, not so much the implant style choice.

William Bruno, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 152 reviews

Avoiding bottoming out

+2

It does not make sense to get larger, and thus heavier, implants to prevent bottoming out. While bottoming out is often a misused term and can be caused by many factors. enlarging the implant is usually not one of the treatments.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 8 reviews

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Breast implant bottoming out

+2

The larger the implants the more the possibility of bottoming out becasue of the weight on the implants.  Therefore, fixing a bottomed out implant and going bigger at the same time increases your risk of repeat bottoming out.   

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 51 reviews

Correction of "bottomed-out" implants

+1

“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 excellt results in the correction of “bottomed-out implants.

W. Tracy Hankins, MD
Las Vegas Plastic Surgeon
5.0 out of 5 stars 47 reviews

Breast Implants "bottoming out"

+1

Many factors can cause breast implants to bottom out.  Women with extra large implants are at highest risk of having breast implants bottom out. This is one of many reasons I don't use extra large breast implants in my plastic surgery practice

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 42 reviews

Implant profile and bottoming out

+1

"Bottoming out" is a term that originally came from breast reduction surgery.  Post-op, we would notice that, over a year or more, the lower half of the breast stretched out, while the nipple position maintained itself pretty well.

While this can happen after augmentation, due to a heavy implant, or stretchy skin, some surgeons confuse this with descent of the implant pocket or  "pocket expansion", which is a different situation.  Here, the implant drops lower, acting like a wedge between the skin and the chest wall, opening up the tissues.  Essentially, the implant is sliding down the rib cage, and the level of the inframammary fold descends, and the nipple starts to point upward.

Based on your information, I can't tell which of these problems you have:  inferior pocket expansion or true bottoming out.

The treatments are different for the two problems - which is why it's important to make an accurate diagnosis.

But no, implant profile by itself has not been linked to a higher rate of bottoming out.

Thomas Fiala, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 33 reviews

Implant profile probably has little effect on bottoming out tendency but surface texture may.

+1

Higher profile implants may actually cause you to have less cleavage and greater distance between the breasts.

Breast implant contour will probably have little effect on the bottoming out. However, surface contour may have a slight effect. Textured implants may diminish this tendency but are becoming increasingly less popular.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 48 reviews

Bottoming out

+1

Going with a larger implant will surely put you at risk for further bottoming out. Bottoming out is a combination of your skin tone and size of the implant. The larger the implant is, the more bottoming out you will notice. If you already have this issue, you should discuss with your surgeon revision of the implant pocket and actually going with a smaller implant to avoid future problems. Over the last 10yrs your skin has aged and the tone decreased. Changes to your skin as a result of aging should also be taken into consideration before choosing a new implant size.

Bahram Ghaderi, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 8 reviews

Bigger implants will increase bottoming out

+1

Hi,

Thank you for your question.

If you want to avoid bottoming out, I would not go bigger. This will only increase your chances of bottoming out because the weight on your breast will be heavier! Textured implants do aid in the reduction of bottoming out; however, they do come with some downsides such as creating a more noticeable rippling effect if your tissue is too thin and not being as mobile. You do have some other options such as a capsular repair to help hold your implant in place and prevent bottoming out. Explore these options with your plastic surgeon. Going bigger is not always the answer.

Best regards,

Dr.Speron

Sam Speron, MD
Chicago Plastic Surgeon

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.