Will I Bottom Out if I Don't Have a Breast Reduction?

DD cup bordering DDD.

I am considering a breast lift and went to my first consultation today. The surgeon recommended I have a reduction, but I'm not looking to decrease the size of my breasts. He said I risk sagging within a few years and possibly bottoming out if I just get a lift without a reduction.

Is breast reduction surgery my only option? Is it possible to possibly lipo out a small amount of tissue and get a lift? How long will a lift last without a reduction for my size? Is bottoming out a serious concern?

Doctor Answers 10

Breast Lift vs. Breast Reduction: Maintaining breast shape and volume

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A breast lift or mastopexy repositions the nipple and shapes the breast. A breast lift is a component of most breast reductions, except in the case of women with little to no "sag" in their large breasts which is uncommon and then, liposuction could be used. A breast reduction is indicated when the breast is too heavy to be lifted. In your case i would agree that you will need some amount of reduction in order to lift and shape your breast. You don't necessarily need to lose all volume in your breasts, but you just cant expect your body's tissues which have already failed as demonstrated by your amount of sagging to support that amount of breast volume you have now. I hope this helps and I am in Dallas, so let me know if you want to discuss this further. Dr. Trussler

Austin Plastic Surgeon
4.9 out of 5 stars 52 reviews

Bottoming out

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I disagree a little with the other authors in that the term "bottoming-out" can be applied to reductions or augmentations; in fact, in my training, bottoming out was one of the concerns in terms of judging breast reduction shapes in comparing vertical with standard techniques. But that is semantics.

Basically, what you want to know is whether your lifted breasts will stay lifted, and for how long. The answer is, like most things, it depends. It depends on how much skin excess you have in the lower pole and how elastic vs. stretchable it is (note: elastic is NOT the same as stretchable; in fact, they mean opposite things). If you  have a mastopexy with a vertical technique, the length of the vertical limb from the bottom of your areola to the fold may lengthen with time as the breast tissue hangs down (like an implant might) into the skin of the lower pole.

An exam is required to assess how loose or stretchy your breast skin is, and to determine what incision approach you need to provide adequate lower pole support to your breast tissue. All lifts involve a slight reduction, actually; you have to take skin and some soft tissue out to shape the breast. So it is semantics in a a way, but the term reduction is typically used to describe a significant amount of breast tissue removal.

Get another opinion or two from board-certified plastic surgeons before you decide. Good luck!

Tim Sayed, MD, MBA, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 22 reviews

Breast Lift and Recurrence of Ptosis

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Thank you for the question.

Recurrent ptosis (sagging)  of the breasts  is very likely after breast lifting surgery. The variables involved include breast size, breast skin elasticity, weight gain/loss, and pregnancies. 

It is best to eliminate as many of these variables as possible prior to mastopexy (breast lift) surgery. For example, if a patient is at her long-term “stable weight” and has no further pregnancies planned  she has remove some of the variables involved in the potential recurrence of breast sagging.

Bottoming out in your case refers to breast tissue that is too low on the chest wall in relation to the nipple/areola and inframammary fold landmarks.  This is a problem seen with patients who have significant breast lifting surgery done while preserving the majority of their breast tissue.

It may behoove you to seek several opinions from well experienced board-certified plastic surgeons (In person).

I hope this helps.


Breast lift vs reduction

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I agree with other posters that the expression bottoming out is misused here. Bottoming out refers to a breast implant appearing to sit too low on the chest, which is not pleasing to the eye. In your case, I think a small reduction is warranted. Otherwise you are at higher risk for further sagging, especially if you go on to gain weight. Mastopexy alone could certainly be performed so long as you accept the risk of reoperation at a later time. The standard breast reduction entails a lift, per se, but also removes excess breast tissue.

Breast lift...will I bottom out if I don't have a reduction?

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In a word, yes.  Even with manipulations of the underlying tissues, breast lifts are essentially skin tightening procedures, and large heavy breasts just do not hold up as well as smaller breasts do.  With your breast size and apparent weight of your breasts, a breast lift would lift your nipples to a higher position and at least initially make them not hang as far over your inframammary fold, but very soon, within months perhaps, your heavy breast will restretch and I would predict that it would settle not much higher than you started out.  You wouls end up with breasts roughly the same as you started with, but with scars and somewhat higher nipples.  And you must realize that no amount of lift will ever give you upper pople fullness, only implants can do that.  You should either not do surgery OR consider a breast reduction, which can be somewhat conservative in amount, with lift.

Breast lift vs breast reduction

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You can certainly have a breast lift and maintain your same size or volume.  The pattern is very similiar for a breast lift vs a breast reduction. I would not be concerned about "bottoming out" if you have a short scar or vertical type of breast lift performed. A board certified plastic surgeon can explain this to you in greater detail during your consultation once you are thoroughly examined.

There are many good plastic surgeons in your area, I recommend consulting with a few of them before making your decision.

Best wishes,


William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 410 reviews

Breast lift

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The larger the breasts, the more likely with a lift that they will relapse sooner than if some weight is removed. A lift certainly could be done without removing much tissue, but some usually is removed to mold it and give it a good shape;

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Will I Bottom Out if I Don't Have a Breast Reduction?

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Technically the term "bottom out " refers to breast implants that sit too low on the chest wall relative to the lower fold/attachment of the breast (aka infra-mammary fold).  You could only have this potential complication if the surgeon was also planning on putting in breast implants during you "breast lift".  Nonetheless it is indeed possible to have a breast lift only in your case. 

Ryan A. Stanton, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 128 reviews

Breast reduction or a lift alone

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The term you are using 'bottomed out' pertains to breast implants. What your surgeon is referring to is the risk of recurrent ptosis or droop in the breast without a reduction with the breast lift. If the breast is reduced a small amount, say a lower central wedge, the gland can be wrapped and shaped to contribute to the stability of the lift, Without, the lift much will rely on the skin envelope and the droop can recur. The second issue is the recruitment of breast tissue as the breast is lifted, making the apparent size fuller after a lift. Your breast is large, and a very small reduction might benefit your lift, and the size difference hard to notice.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Breast reduction is often an important part of a breast lift procedure

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Based on your photo - I would recommend a small breast reduction on both sides - it will vaslty improve your breast shaping and the longevity of the result. The issue is the sagging tissue you have below the fold beneath your breasts. This tissue is always going to sag, no matter how it is repositioned with a breast lift. Your best option is to remove is completely. You should have a nice result with an experience plastic surgeon.

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.