Breast Implants: Q&A

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Bottoming out of Breast Implants the Fault of Surgeon?

I think my right breast implant has bottomed out. I noticed the difference within a month of the original surgery. When I lay on my back the right implant falls into the axillary area. Both breasts are very soft and the implants can easily be moved around. Was this the fault of the surgeon, and if so, what type of fee reduction should I ask for on his part for the revision? It has been 18 months since the original surgery, but he has been aware of the issue since 3 months post-op. Thanks!

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15 Doctor Answers | Asked by Shepard OK in Iowa

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The pocket was likely made too big

When a breast implant moves or falls into the axilla it is usually because the Serratus Anterior muscle was violated during surgery in the case of a submuscular implant. If a subglandular breast implant was done, then the pocket was made too large and extended too far laterally. This is especially true if the problem was noted in the first month or so after surgery. You need to review your photos and discuss this with your surgeon. Revisions are expensive and my own view is that expenses... more

Is it bottoming out?

Bottoming out to most surgeons means that the implant settles or slides below the inframmamary fold and the nipple areolar complex looks too high. What you describe is a lateral pocket overdissection or tissue stretching that allows the implant to slide laterally. Unfortunately, it is pervasive thinking in our society, that if something is not "perfect" one must find someone to blame and ask for renumeration. It is most likely no one's fault. You do not state how thick your skin is... more

You need a surgical revision to fix the breast asymmetry

I certainly appreciate your concern. It is time for you to have a heart-to-heart discussion with your plastic surgeon regarding your post operative results. Unfortunately, you are in need of a surgical revision. There is obvious breast asymmetry do to mal-positioning of the breast implants. I would recommend that you return back to your original plastic surgeon and discuss your options at length. Of course, fees will be a topic that needs to be addressed. I’m sure that your plastic... more

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Lateral displacement (movement into armpit) of implants can be repaired

Movement of the implant into the axilla is not necessarily a sign of bottoming out. In my practice, I often see this in a few repeated scenarios: patients who have submuscular placement of the implants and then return to agressive pectoralis strengthening exercises which causes lateral displacement of the implant with muscle contraction patients with a pigeon chest deformity called pectus carinatum patients with lax tissues and subglandular placement. In many instances, I have repaired... more

Bottoming out

Bottoming out actually refers to the implant falling below the fold. If the implant is going into the axilla, the pocket obviously has enlarged. It is often not the fault of the surgeon. Any reduced fee should be discussed with the surgeon but not to be definitely expected.

Steven Wallach, MD

13 reviews

Manhattan Plastic Surgeon

Usually a combination of factors

Bottoming out or stretching of the lower portion of the breast causes the implant to appear lower than desired. This can be simply a results of skin type which is prone to easy stretching and looseness. A non-surgical example would be pregnancy where some women have no residual loose skin after giving birth and some women need a tummy tuck due to the loose skin. Another factor would be the size of implant chosen. The bigger the implant, the more chance the skin will stretch. Every surgery... more

Bottoming out of Implants

Any time that a procedure is performed there are risks that are involved and some are less frequent than others. Even if a complication occurs that was a known risk, rather than look for blame or fault, most plastic surgeons will work with the patients to decide what the best procedure to resolve the issue is and usually give a significant reduction in the surgeon's fee (he may have no control over the facility fee and anesthesia). This is not an admission that either the patient or the... more

Consequence of Implant Pocket too Large

Without photos or an exam, it is difficult to comment as it is unclear the exttent of your problem. That being said form your description it appears that the pocket was made too generous rather than bottoming out (implants too low). The best tact would be to have a candid discussion with your plastic surgeon. Although there are rarely implied or actual guarantees of surgical results as plastic surgery is an inexact science, most surgeons will be reasonable and work with you to acheive a... more

Bottoming out of Breast Implant?

Thank you for the question. Without pictures or examination it is not possible to give you specific advice. Based on your description however you may be experiencing inferior (bottoming out) and lateral (sideways) implant malposition. Although frustrating, the entire malpositions are not necessarily the fault of the surgeon. One of the most common complications after breast augmentation surgery is implant malposition. This occurs when the implant is in an... more

Bottoming out of implants has a variety of etiologies

“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... more

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