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Am I Starting to Bottom Out?

asked 1 year ago by belladaniela
Latest answer by Rian Maercks, MD
Question viewed 2,197 times
Tags: 110-129 lbs, 5 ft 0 in to 5 ft 3 in, bottom out

I think I may be bottoming out. I am noticing the formation of a double bubble. What is your opinion and how soon can I have a revision? I had my augmentation 13 weeks ago and I chose 400cc mod-plus silicone implants. Also, if I were to go about 100cc's bigger would it be likely to happen again? I am 5'2" and 110lbs. Thank you in advance for your response.

25 answers to Am I Starting to Bottom Out?

+3

How patient are you?

You clearly demonstrate a small double bubble deformity. This was likely due to the surgeon lowering the infra mammary fold to accommodate the implants. That may improve in time but it also could get worse. You are best served waiting until everything is stable, usually about six months, if not more. The implant will not go up on it's own. Surgery to resuspend the implant is difficult. Putting in a bigger implant or a higher profile implant may correct the pseudo-ptosis appearance but... more
Peter D. Geldner, MD

Chicago Plastic Surgeon
+3

Settling vs. Bottoming Out

From your photos, it appears that you have had settling of the implants, rather than bottoming out, which will cause the nipples to point too high. The "double bubble" crease would be made worse by a larger implant. If it disturbs you enough to have further surgery, this can sometimes be improved.  Best to consult your surgeon about that possibility, but allow about 6 months for all the tissues to settle first.
Paul C. Zwiebel, MD

Denver Plastic Surgeon
+2

Implants are moving below your breast crease

It looks like your implants are lower than your breast fold.  You can have this repaired by removing the implant and repairing the inframammary fold.  It would be best to wait about 3 months for swelling to decrease and the implant to settle.  If you decided to increase the size of your implant, the chance of bottoming out or sagging of the breast itself would actually be a little bit higher.  We don't know exactly what size you need to stay below to decrease this... more
Bivik Rajnikant Shah, MD

Columbus Plastic Surgeon
+2

Right size implants for optimal asethetic result

Your implants seem to be bottoming out most likely due to migration of implants downward beyond the natural breast fold.  The solution will be to remove the implants, repair and re-establish the natural breast fold by closure of the lower pockets using heavy, absorvable suture material.  I do not reccomend going to larger size implants at this time because the excess weight of the implants may rupture the repair resulting in reccurrence of your problem.   ... more
Ivan Thomas, MD

Los Angeles Plastic Surgeon
+2

Bottoming out

Based on your photo, I see an area on your left breast where your own breast tissue stops that still looks a little "tight" and "band like".  Since your surgery was very recent, it's probably best to wait and see how this goes on it's own.  It may settle with time and massage. Radial scoring, done internally, of the tight band can help.  Do you know if your surgeon has done this already at the time of your first surgery?   If after... more
Thomas Fiala, MD

Altamonte Springs Plastic Surgeon

www.plasticsurgeryinflorida.com

+2

Bottomed out implants

Bottomed out implants are cases that I look forward to because I know how to fix them.  It depends on the etiology of the failure and sometimes it is because of your tissues.  Even in this case we are aware of how to fix the deformtiy.  Your left side may have not been released enough internally to make that shadow of the fold go away but now that the fold is visible, you likely will need a revision surgery.  I've not seen this settle out on it's own. ... more
Ricardo A. Meade, MD

Dallas Plastic Surgeon
+2

Not bigger implants

Your left breast inframammary fold is separated from it's attachments to the rib cage and causing doble bubble. You will need revision and if you bigger the problem will return.
Kamran Khoobehi, MD

New Orleans Plastic Surgeon
+2

Bottoming out - implant placement vs. migration

The bottom portion of the implants are below the inframmary fold and the center of the breast.  This creates a double bubble effect.  There are two main reasons why this happens.  Either the implant was placed too low or the implant has migrated.  Contributing factors to implant migration include disruption of the inframmary fold, implant size, capsular contracture, and failure to release a portion of the pectoralis muscle.  Placing a larger implant will likely... more
LaDawn Talbott, MD

Reno Plastic Surgeon
+2

Bottoming out of implants?

I don't see bottoming out.  In fact I think that the implants are still a bit high.  I also feel that the diameter is a bit small, so a larger implant may actually help. The double bubble especially on the left, ? on right (if at all) is due to connective tissue in the lower pole of the left breast.  A rivision with radial scoring can be considered with or without exchange of implant, but I would wait 6 to 9 months at least, and preferably a year after the original... more
Scott E. Kasden, MD

Dallas Plastic Surgeon
+2

Bottomed out implants need to be revised.

It looks like your implants have bottomed out.  You should schedule an appointment with your PS and talk about a revision. see video
Otto Joseph Placik, MD

Chicago Plastic Surgeon
+2

Bottoming out of implants

My expectation is that you naturally have a degree of laxity of tissue in the inferior lateral location.  It is early to be sure of the exact location of your implants once they fully settle although they will likely look somewhat low.  In general the appearance seems fine and the best advice may to leave things alone and wear a push up bra as needed.  Larger implants are likely to further stretch the lower pole and going larger may not be the best idea.
Terrence Murphy, MD

Englewood Plastic Surgeon
+2

Bottoming Out Breasts

Regarding: "Am I Starting to Bottom Out? I think I may be bottoming out. I am noticing the formation of a double bubble. What is your opinion and how soon can I have a revision? I had my augmentation 13 weeks ago and I chose 400cc mod-plus silicone implants. Also, if I were to go about 100cc's bigger would it be likely to happen again? I am 5'2" and 110lbs. Thank you in advance for your response." You do demonstrate mild bottoming out but the solution, if there... more
Peter A. Aldea, MD

Memphis Plastic Surgeon
+2

Breast implants below the breast fold, bottomed out

Breast implants are best positioned centered within the breast, though with a very full augmentation the implant may sit snugly and push the breast fold lower. The skin of the breast will give to accommodate the implant, a process we refer to as settling in. If the pocket is not planned well and the implant is too large the implant can push under the breast fold. The implant will look low and 'uncentered' and the nipple can look too high. This is the look of a bottomed out... more
Peter E. Johnson, MD

Chicago Plastic Surgeon

www.peterejohnsonmd.com

+2

Your breast implants are not bottoming out.

All breast implants will 'settle' a llittle in time.. Yours look just fine, and I would leave them alone. Going to a larger size sill not improve the appearance, and would be pretty big for your figure. The 'double bubble' comes from putting large implants into a small breast. Bigger implants will make it worse or make the upper pole too prominent.
G. Gregory Gallico III, MD

Boston Plastic Surgeon
+2

Bottoming out?

It looks like you are bottoming out, and you may be better off downsizing and raising the fold back up as well.
Steven Wallach, MD

Manhattan Plastic Surgeon
+2

Am I Starting to Bottom Out?

Thanks for the photos. Very hard to be definitive but you are on the + side of "bottoming out". The risk of revision or increase size of implant is to worsen what you already have. Seek more in person evaluations. But my guess is a 500 cc HP with fat grafts to the crease areas to correct. Costs for revision $8,000 in MIAMI. Dr. D Blinski
Darryl J. Blinski, MD

Miami Plastic Surgeon
+2

Bottoming out

Yes you are bottoming out with a visible double bubble.  This will not self correct and going bigger will make it harder for the repair to work.  It's not that easy..
Richard P. Rand, MD, FACS

Seattle Plastic Surgeon
+2

Am I" bottoming out?"

It is impossible to say unless you compare nipple- to -inframammary crease distances preoperativly and now.Even when appropriatly sized implants are used there is some small increase in this measurement as the operation matures and softens. This usually does not interfere with the breast aesthetic.  Remember that the larger the implant the more it weighs which can cause more stretch which may lead to "bottoming out"
Barry H. Dolich, MD

Bronx Plastic Surgeon
+2

Implant revision

I do not have access to your preoperative photos but by the appearance of your pictures and your description I would recommend not doing anything.  Right now you have a very acceptable shape and appearance.  Make sure to use good bra support when you are active and exercising.  Larger implants will likely cause other problems.  You have a nice result at this time. Best Wishes Dr. Peterson
Marcus L. Peterson, MD

Saint George Plastic Surgeon
+2

Bottoming out after breast augmentation.

Thank you for the photo. Although in one view it is hard to appreciate the results, I do see a crease on the left side. The nipple s are positioned at the most projecting part of your breasts, although there's some asymmetry. The "double bubble" is your old crease that your surgeon had to dissect through to place the large implant that you decided on. Adding another 100 cc will not make this go away, but it could lead to bottoming out. You are only 3 months from your... more
George Marosan, MD

Bellevue Plastic Surgeon

www.bellevueplasticsurgeons.com

+2

Bottoming out

There is a difference between bottoming out (which is a dynamic situation implying that either tissue or the implant is sagging or slipping lower than intended) and mismatch of the implant and breast. Your implant may be appropriately positioned for the location of your nipple but too large as to its dimension causing it to extended below the lower margin (i.e. inframammary fold) of the breast. You and your surgeon will have to decided which of there situations exist 9or both). Going larger... more
Robin T.W. Yuan, MD

Beverly Hills Plastic Surgeon
+2

Bottoming out vs Double Bubble: bigger may not be better

Of course you understand that no one can give you a definitive opinion based only on pictures, though they are helpful. Yours don't show much in the way of bottoming out, in which you would see an increase in the distance from the bottom of the areola to the bottom fold of the breast. Double  bubble is a distinctively different problem but can occur together with bottoming out. In this case, you would see a horizontal groove across the bottom of the breast. This might be at the... more
Richard Baxter, MD

Seattle Plastic Surgeon
+2

Larger Implants Increase Chance of Bottoming Out

I see no evidence of bottoming out on your photos (although it would have been helpful to have both pre-op photos and laterals).  However, replacing your implants with larger ones will increase the chances of bottoming out.  It appears as if you may have had some pre-op ptosis, but again a pre-op photo was not available.
John Whitt, MD

Louisville Plastic Surgeon
+1

Correcting submuscular bottoming out with subfascial placement

There are several things that create the undesirable aesthetics. Firstly the implant base width appears to be too narrow for your chest wall dimensions. Secondly th, you have undesirable lateral inferior stretchning that is very common with dual plane placement. Placing breast implants under the muscle creates a few aesthetic problems. If you look at your picture, your breasts are too far apart at midline to have a natural appearance. any time your arm moves this... more
Rian Maercks, MD

Miami Plastic Surgeon
+1

Breast augmentation -getting it right the first time

It is hard to see in the photo because the lighting from above instead of directly in front creates a shadow but I see the crease under the left breast is lower than the right, the inter-nipple distance is greater than sternal notch to nipple distances (so the nipples do not point straight forward) and there is no incision visible on the breast. I assume you had a the implants placed through the belly button or possibly the armpit. It's more likely that it was done via the belly button... more
Aaron Stone, MD

Los Angeles Plastic Surgeon

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