Internal Stitches to Prevent Bottoming out - Normal?

My PS told me after I woke up from my first BA that he put in internal stitches in to prevent bottoming out, is this common for doctors to do? Thanks so much for any answers!

Doctor Answers (14)

Breast Augmentation - Sutures to Prevent Bottoming Out?

+2

Hi aprildawnxo,

It may or may not be normal - but it sounds like it was a good thing to do in this case.

It is hard, of course, to make a comment without seeing what you looked like before.  And I'm assuming that this was a primary breast augmentation (ie, it was not a redo.  In secondary - revision - breast implant surgeries, it is a lot more common to use sutures/stitches such as these).

As far as I know, most surgeons do not use such sutures as part of primary breast augmentations; I normally do not.  But I would not hesitate to do whatever I thought was necessary at the time (that's a rather broad statement, and should be considered to go outside the scope of what is discussed as part of the general discussion and informed consent!).  That would certainly include the placement of any stitches necessary to prevent bottoming out.  Perhaps the surgeon saw there was a weakness, whether actual or anticipated, at several sites along the bottom of the pocket.  Maybe they were large implants for the skin envelope.

There are many maybes, and no way for any of us to guess.  But even if it is not "normal" it's much better that your surgeon anticipated a potential problem and addressed it at that time, than any of the other scenarios.

I hope that this helps, and good luck,

Dr. E


New York Plastic Surgeon
5.0 out of 5 stars 150 reviews

Bottoming Out in Breast Augmentation

+2

The answer would depend on what your plastic surgeon meant by "bottoming out". If he or she placed internal stitches to prevent the breast implant from drifting below the breast fold, it sounds reasonable although it is probably not necessary to use permanent stitches because once the pocket and capsule have formed things should be stable. However, the "bottoming out" that occasionally occurs through stretching of the skin and soft tissues of the lower part of the breast will not be prevented with internal stitches. The best prevention is good muscle coverage of the lower part of the implant, wearing a bra, and not using an implant that is too big and heavy for your body.

Joseph Fata, MD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 56 reviews

Bottoming out after breast surgery

+2

I personally do not use any sutures to prevent bottoming out (nor do I know any colleague who does) and do not particularly believe in them. However, I have no doubt that your surgeon did what he thought was best for you at the time of the operation.

Anindya Lahiri, MBBS
Birmingham Plastic Surgeon
5.0 out of 5 stars 5 reviews

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Sutures for Bottoming Out

+1

Bottoming out or stretching of the lower pole of the breast in usually seen after previous breast implant surgery. Photos would certainly be helpful but I am unaware of surgeons placing sutures in a primary breast augmentation to prevent this problem.  Avoiding this problem by not placing the implant too low and choosing the appropriate size implant is the best course. Are you happy with the way your implants and your surgeon? If the answer is yes, then do not worry.

Richard Linderman, MD
Indianapolis Plastic Surgeon
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Internal Sutures and Bottoming out

+1

I have used internal sutures to correct bottoming out.  Sounds like your surgeon was doing something else. Like the rest of the panal has stated, if you look good and have no issues, you should not worry about it. Enjoy your results.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 718 reviews

Sutures for bottoming out

+1

Some surgeons pale sutures in the pocket to maintain a specific size, and also maintain the fold. I do not routinely place internal sutures in the pockets of  primary ( first time surgeries) breast augmentation patients.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Bottoming out

+1

i am not aware of  internal sutures placed propylactically. i am not sure what the surgeon would be sewing.  if they look fine dont worry about it

Jonathan Saunders, MD
Newark Plastic Surgeon
5.0 out of 5 stars 29 reviews

Bottomong out of breast implants

+1

Most plastic surgeons do not use sutures to prevent bottoming out in a standard breast augmentation, although some do. The chances of bottoming out of implants can be reduced by not over dissecting the region of the lower breast fold.

David A. Bottger, MD
Philadelphia Plastic Surgeon
5.0 out of 5 stars 26 reviews

Internal sutures to prevent bottoming out?

+1

Although I do not use internal sutures to prevent bottoming out in most primary cases of breast augmentation (where they are usually not needed), there are surgeons who do.  There is no right or wrong approach.  Those surgeons who do not use them try to control bottoming out by accurate pocket dissection and post-op bras.  Those that do add one or more internal sutures as "insurance" against bottoming out...they may work, they may not.  But if your results are good, whatever works in your surgeon's hands is the right technique.

Robert M. Grenley, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 70 reviews

Bottoming out with breast implants

+1

I have never placed internal sutures to prevent bottoming out.  I have used them to CORRECT someone who has already bottomed out.  I assume that you are not having a revision? As previously stated in this post, a lot of us do things differently and there is rarely a "right" answer.  As long as they look great then I wouldn't worry about it.  Good luck!

Tiffany McCormack, MD
Reno Plastic Surgeon
5.0 out of 5 stars 22 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.