Will permanent stitches correct bottoming out?

I had a breast augmentation 01/16. I've had several follow ups since, because my right breast was much lower than the left. Initially the doctor thought it may have "dropped" earlier than the left. At my last follow up he agreed that it was not where it should be. The scar is in the middle of the bottom half, my nipple is much higher, and now that I'm regaining muscle it is even more prevalent. He suggested putting in permanent stitches, which I'm scheduled to have done in two weeks.

Doctor Answers 12

Permanent Suture Repair


Thank you for your question. Repairing and reinforcing the implant pocket with a capsulorraphy procedure could be done with permanent or dissolvable sutures. Your Plastic Surgeon will have assessed your tissue and determined if that approach will be sufficient and strong enough. You may need to wear a specific surgical bra post op and will need to follow post op instructions carefully.

All the best

Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Supporting Fallen Breast Implants

Implant displacement, or malposition, can be corrected with a variety of options - including stitches (capsulorraphy), mesh support, capsular flaps, changing implant plane, etc. Options can be used alone, but are often used in combination. I have found that combining techniques proves to be more effective in offering long-term support than any one technique alone. Implant size may also have to be considered - a large implant will weigh heavily on any repair intended to reinforce the lower breast fold. All the best.

Brian M. Derby, MD
Sarasota Plastic Surgeon
5.0 out of 5 stars 39 reviews

Bottoming out

Often a capsulorrhaphy alone or stitches within the capsule can improve bottoming out. I like to have patients wear a special bra after the procedure as well.

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

Bottoming out

The type of suture is not that important in these situations.  The repair of the inframammary fold has to be adequate but some surgeon's use dissolvable sutures that work just as well.   You need a strong repair that will hold until the capsule reforms in the proper location and bottoming out will be avoided. 

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 52 reviews

Bottoming out

Done well, this can be a good solution. It also depends on the "quality" of the deeper tissues. If these are thin and weak we sometimes need to add a supporting "dermal substitute" material to create an adequately supportive and secure "sling" for the implant to sit on.

Robert H. Hunsaker, MD
Miami Plastic Surgeon
4.5 out of 5 stars 82 reviews

Bottoming out post aug

Sometimes the breast ligaments are weak and this can be due to thin tissues and also multiple pregnancies and putting in permanent sutures can help correct this.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 65 reviews

Bottoming correction after breast aug.

I am sorry that you are having issues about your procedure and thanks for sharing your question. I can appreciate your concern.

Yes. permanent stitching is a good way to control breast pockets that have gone too far. 

Your Doctor is taking the correct steps. Have an open conversation with her/him, as you progress with your surgery.

Wishing you the best in your journey

Bottoming Out Repair

Bottoming out of an implant is very often repaired with permanent sutures in various techniques utilizing the capsule for strength.  This is called a capsullorhaphy or internal bra.  There are some patients who need more than this type of repair and will require some added material to support the implant.  Make sure that your board certified plastic surgeon is comfortable performing revisions since not all surgeons are adept at it.  I hope this helps.

Christopher V. Pelletiere, MD
Barrington Plastic Surgeon
4.8 out of 5 stars 75 reviews

Bottoming out

Hello, inserting permanent or slowly-dissolving sutures along the lower fold of the breast is one way to correct bottoming out.  There are other options like temporarily removing the implant and allowing the breast to heal, inserting the implant into a different pocket, using a special material to act like an internal sling, etc.  They all have different advantages and disadvantages so your surgeon will be your best source of advice, based on your unique anatomy and problem.

William Andrade, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 66 reviews

Will permanent stitches correct bottoming out?

I am sorry to hear about the complication you have experienced. Yes, the use of permanent sutures can be very helpful when it comes to correcting "bottoming out" of breast implants;  this procedure is called capsulorraphy.   In my practice, I find that the two layer repair utilizing permanent sutures is usually successful;  sometimes the use of additional material such as acellular dermal matrix or biosynthetic mesh may be helpful depending on the patient's specific situation.

Hopefully, you are working with a board certified plastic surgeon who can demonstrate significant experience helping patients with this type of revisionary breast surgery. You may find the attached link, dedicated to "bottoming out" surgical correction cases helpful to you as you learn more.  Best wishes for a successful outcome.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,503 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.