What is the Chance of Bottoming-out with Implant Via the Nipples?

Doctor Answers 9

Breast Implants Bottoming-Out

Implants can bottom out no matter where the incision is done. The forming of the pocket more likely determines bottoming out.

San Antonio Plastic Surgeon
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Bottoming out of implants

Bottoming out of implants can occur from any approach to place implants.  It usually occurs with over dissection of the inframmary fold and sometimes in patients with poor tissue quality with large implants that stretch the lower portion of the breast.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 9 reviews

What is the Chance of Bottoming-out with Implant Via the Nipples?

It can happen with any incision used however I personally think it is more possible with an infra-mammary incision due to the possible disruption of dermal attachments to the chest wall. I use the underarm approach almost exclusively and I RARELY see implants drop too low. I am also of the opinion that most women need their fold lowered to get the implant centered under the nipple but we do tend to use a bit bigger implant here in Scottsdale too!!!

John J. Corey, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 24 reviews

Bottoming out

Bottoming out of an implant means that the implants descends low on the chest and below the breast crease. This can give the appearnace of upward pointng nipples in some patients.  If the implant comes out from the nipple incision, that is an extrusion and the implant needs to be removed.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Bottoming Out of Breast Implants

"Bottoming out" happens when the implant drops below the breast crease. The incision location does not contribute to bottoming out. If adjustments are made to the crease, or if the crease is not well formed, bottoming out may happen.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
5.0 out of 5 stars 27 reviews


Thank you for the question.  As the other surgeons have noted, the incision really has nothing to do with bottoming out.  The factors that you should discuss with your surgeon include your starting anatomy, implant size and sometimes implant type.

Peter A. Lennox, MD
Vancouver Plastic Surgeon
5.0 out of 5 stars 5 reviews

Breast implants bottoming out

Bottoming out occurs when the implants go below the inframammary crease which is nature's best barrier to implant descent inferiorly.  Occasionally, the crease needs to be lowered because of your starting point but this should not be done routinely if possible.  Some patients also have a very vague poorly made natural crease and this increases bottoming out risks.  The incision really has nothing to do with it. 

I advise my patients to wear a custom fit underwire bra for 3 months and in the last 2 years, implant malpositions have been extremely rare.  I also restrict them during that period from activities like running and heavy pec workouts that might also move the implants while they are healing.

Bottoming Out of Breast Implants?

Thank you for the question.

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 (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).

Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. This is corrected by “raising” the inframammary fold using internal sutures. This is done after careful measurements are made from the areola to the “new” inframammary fold.

Chances of bottoming out of implants  when placed through an incision under the areola is very small. In my opinion, the chances of implant  malposition are  greater when implants are placed through a “remote” incision line such as the trans-axillary  or trans- umbilical approach.

Of more importance to the success of your operation ( than selection of incision site) is  careful selection of a well experienced board-certified plastic surgeon.

I hope this helps. 

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.