All About Bottoming Out! What Are the Real Facts on This Complication?

Hi Docs!! I am about to undergo a Breast Lift with Silicone Implant placement. I was informed by my surgeon that bottoming out/star-gazing nipples could be a possible complication for my particular case (Iam thin, have thin tissue and want to go with 460cc silicone unders). I was just wondering what the odds of this happening are? When could it happen? Is there anything I can do to help prevent it, like constantly wearing a good bra, etc?

Doctor Answers 4

Bottoming out

Bottoming out occurs when the weight of the implant combined with compression by the pectoralis major muslce creates a downward displacement of the implant.  The overlying tissue expands, stretches and bottoms out.  It you want to prevent bottoming out, smaller implants and high position is better.  Since you are undergoing a breast lift, your breast position is not optimal.  Unfortunately, you have not provided us with any photographs but you may be a candidate for a new procedure called Breast Augmentation with Mini Ultimate Breast Lift.  This incision is around the areola, the areola is elevated, the breast tissue elevated and the implants are placed high under the pectoralis major muslce.  Aligning all 3 increase projection and give the appearance of large breasts with smaller implants.

Best Wishes,

Gary Horndeski, M.D.

Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

Bottoming out

Bottoming out is more common with larger implants and when the folds are undermined to correct asymmetries or to accommodate the implants.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Larger implants increase risk of bottoming out

Thank you for your question.  Bottoming out can happen to anyone.  The risk of this happening is increased in patients with thin, inelastic tissues.  Also, larger implants, which are therefore heavier, can more easily stretch the skin, and thus larger implants are more likely to lead to this problem.  Patients who are having breast lifts usually already have a problem in that their skin is very stretchy. So while it is impossible to say what will happen in your case, the fact that you are having a lift and therefore most likely have stretchy skin and you are having fairly large implants, means that you are probably at a slightly higher risk than someone else for this issue developing.  I would suggest you use as small an implant as possible, consider a textured implant, wear a very supportive bra 24/7, wait several weeks before returning to exercise, when you do exercise do not let your breast bounce and follow your plastic surgeons recommendations.  I am glad you are not having saline implants placed because these are heavier and less compressible, and therefore stretch the tissues more.  Good luck with your surgery.

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 29 reviews

Lift and implants and bottoming out

Simultaneous lift and implants can be a difficult operation. To get the nipples in exactly the right place is tricky because the right place doesn't exist until the breasts have adjusted to the implants. Plastic surgeons do not want the nipples too high. Surgically you can move nipples up much more easily than they can be moved down. A natural look for a full breast (C-D) will have a bit more distance from nipple to the fold than a smaller breast.  Mention your concern to your surgeon.  Supportive bras help, but the real outcome depends on the surgical plan and the weight of your future breasts, and your tissues.  Good luck and best wishes.

Brent A. Buchele, MD, MBA
Kalispell Plastic Surgeon
5.0 out of 5 stars 5 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.