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Is my Implant Bottoming Out?

I had breast augmentation done almost a year ago, and my left breast has always had the incision above my crease. It seems too low and outward. Is my implant bottoming out?

Asked 39 months ago by MichelleDS in Indiana

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bottom out

Are You "Bottoming Out?"

"Bottoming out" is the term used to describe a downward malposition of a breast implant, below the natural breast crease: the nipple seems to point upward the breast seems too low the upper pole of the breast lacks fullness an inframammary scar (crease incision) will seem to "move" higher on the breast, farther above the crease Do have your surgeon examine you to see if you are devloping a malposition that might require correction.... more

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Paul C. Zwiebel, MD

Denver Plastic Surgeon

ASAPS ASPS

South of the Border?

Michelle, It indeed sounds as if your implant on the left has gone south of the border. This may be due to the technical creation of the implant pocket during your surgery or the effects of gravity, (more common with larger, heavier implants). If there is a significant asymmetry compared to the opposite breast you should consider having it fixed with an internal repair of the pocket. Most surgeons will perform this procedure with minimal or no cost if within a year of the initial... more

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Kenneth R. Francis, MD

Manhattan Plastic Surgeon

ASAPS ASPS

It might be, but we can't say for sure unless you are examined

Hi Michelle. The above answers are accurate and I agree with all of them. "Bottoming out" does happen with larger implants and with gravity. However, if your incision has ALWAYS been "high" and your nipple appears slightly higher than the center of the implant, then it is likely that the space created for the implant (pocket) was too low. The only real way to answer you is to look at both breasts and determine the cause of the high incision. Seek out a qualified plastic surgeon in Indiana... more

Sirish Maddali, MD

Portland Plastic Surgeon

It sounds like "bottoming out"

If you have a reasonably large and heavy implant, the chance of it migrating south below your crease is higher. This is what is meant by the implant bottoming out. It can be corrected by repairing the pocket but if it is large, the problem may recur. If it was below the crease from the start, there may have been a problem with how the pocket was made.

Richard P. Rand, MD, FACS

Seattle Plastic Surgeon

ASAPS ASPS

When Implants Cross The Line

Under most circumstances, Breast Augmentation through an inframammary fold incision is planned in such a way that the location of the incision should coincide with the eventual or planned level of the fold. If the implant now lies below the fold, and the incision appears to ride up onto the undersurface of the breast/implant, your implants may indeed be "bottoming-out". Larger, heavier breast implants especially, as well as those placed under the muscle, may have a greater tendency to... more

Athleo Louis Cambre, MD

Los Angeles Plastic Surgeon

ASAPS ASPS

You may be right

Michelle, Sometimes after breast augmentation, the implants "settle." However, as you state, your problem has "always" been there. It sounds to me more like your implant was malpositioned from the beginning. However, without examining you and seeing your pre- and post-op photos, it is hard to tell for sure. At this point, you will likely need a revision surgery to reposition the implant. This can be done through the same incisions (assuming you either had a infra-mammary fold or... more

David Shafer, MD

New York Plastic Surgeon

ASPS

You are describing post breast augmentation ptosis

Ptosis describes the sagging of a breast. Almost all woman with breasts will experience some form of ptosis during their lifetime. Gravity is the number one reason. Pregnancy is another cause. As the breasts enlarge during pregnancy, the tissues stretch out and afterwards they will often not return to its original position. A third form of breast ptosis occurs as a result of the extra weight placed on the breasts from breast implants. What you are describing is none of these things- it is... more

Robert M. Freund, MD

New York Plastic Surgeon

ASPS

Breast Implant Bottoming Out?

Thank you for the question. Based on your description of breast implants “too low and outward", you may be experiencing breast implant malposition ( bottoming out and lateral displacement). One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly... more

Tom J. Pousti, MD

San Diego Plastic Surgeon

ASAPS ASPS

Sound like the breast is bottoming out

“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... more

W. Tracy Hankins, MD

Las Vegas Plastic Surgeon

Bottoming out of breast implants

The only way to know for certain if your breast implant is bottoming out is to be examined by a board certified plastic surgeon. If this is the case, you may need a repair using a reconstructive tissue matrix, which is essentially a type of pig skin. This is also known as an acellular dermal matrix which can be sutured into place to reinforce the fold and maintain the breast implant position. Some commonly used products for this purpose are Alloderm and Strattice. Please see... more

William Bruno, MD

Beverly Hills Plastic Surgeon

ASAPS ASPS

Scars after breast implants

The inframammary incision tends to be become more apparent with maturation of the breast implant shape and final positioning. There are many alternatives to scar revision if this is the case.

Raffy Karamanoukian, MD

Los Angeles Plastic Surgeon

Breast implant bottoming out

You'll need to be examined by a board-certified plastic surgeon to know for sure, but it sounds like you may have bottoming out. Bottoming out occurs when the implant slides below the natural breast crease. That makes the nipple ride high and the upper part of the breast appears flatter.

Carmen Kavali, MD

Atlanta Plastic Surgeon

ASPS

Implant Bottoming Out

It is difficult to give you definitive advice regarding the position of your implant without examining you or seeing your picture. I would recommend you see your surgeon or a Board Certified Plastic Surgeon who can assess the fold competence and provide you with a structured plan. If it is "bottoming out", your fold will need to be reconstructed (much like building an internal bra) to support the tissues and bring the implant back up to where it belongs. Judging fold... more

John Philip Connors III, MD

Atlanta Plastic Surgeon

ASAPS ASPS

Breast implants and bottoming out

A breast implant that "bottoms out" is evidenced by a rotation of the nipple upwards and a loss of projection in the upper pole of the breast. The implant essentially stretches out the lower portion of the breast and "drops." This occurs more commonly with very large implants. However, as you describe it, you say your inframammary incision used to be above the crease but now is "too low and outward." This gives me the impression that the incision appears to... more

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David Bogue, MD

Boca Raton Plastic Surgeon

An implant can "bottom out" if the inframmary crease is damaged.

There are several reasons why an implant might appear to be "bottoming out". Sometimes, the inframmary crease can be damaged. Although it can be surgically fixed with the implant in place, most of the time I recommend removal of the implant and capsule for 6 weeks to three months and then reinsert the prosthesis when the crease has reestablished itself. Often, the implant will be in front of the muscle as the activity of the pectoralis can create a vector of... more

Vincent N. Zubowicz, MD

Atlanta Plastic Surgeon

ASAPS ASPS

Bottoming out of breast implant

Breast augmentation is the most common cosmetic surgery in the United States because it provides a consistent way for a woman to change the shape, position and size of her breasts. After a breast augmentation surgery, it is possible that the patients may heal differently and may develop some asymmetry. It is also possible that one implants may appear slightly lower than the other. If you are concerned, be sure that you're working with a board-certified plastic surgeon who has a... more

B. Pat Pazmino, MD

Miami Plastic Surgeon

ASAPS ASPS

Breast Implant sagging VS "bottoming out"

One of the potential complications of placing the implant in an under the breast fold incision is bottoming out - the implant raises the incision and "water hammers" itself progressively lower. Ideally the incision is placed where the surgeon envisions the new infra mammary breast fold, downward traction during and after surgery combined with a large implant and over-dissection (IE large pocket creation) sideways) are likely to create a bottoming out scenario. You will require... more

Peter A. Aldea, MD

Memphis Plastic Surgeon

ASPS

Breast deformity after breast augmentation can be corrected.

Hi. It sort off doesn't matter what you call it. If your breast doesn't look right, that's a complication. It sounds like you have "bottomed out". The good news is that a revision will almost certainly fix this.

George J. Beraka, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Breast Implant Bottoming Out

It is very difficult to answer your question just based on where the incision is located. I would have to see some pictures to tell you if you are bottoming out. Usually, bottoming out implants tend to have the nipple too high, meaning that the nipple would seem to be almost pointing upward toward your head and too much implant below the nipple. I would post some photos if you need any further help. Good luck.

Farbod Esmailian, MD

Orange County Plastic Surgeon

ASPS

Augmentation incision and implant

Without seeing your photos and where you started after surgery, it is diffiuclt to give you a definitive answer. If you notice that your incision is slowly rising on your breast, then I assume the implant is going South so to speak.