Best Way to Fix Bottomed out Breast Implant?

I got breast implants on February 26th, so almost 8 weeks. I had concerns about my left breast (when looking at me) from about 4 weeks post op. Today, I went to my PS and the Nurse stated that it looked like it had bottomed out. I am a thin patient )105lbs, 5ft2in. 34A pre-op and did 330cc implant filled to 380cc. My breasts before were very symmetrical though! Dr. said that we will wait at least 6 mths before we decide on anything. He would never say to me bottoming out though. What is best way 2 fix it?

Doctor Answers 16

Fixing bottoming out usually equals capsullorhaphy

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

“bottoming out”  is the term used to describe the condition which occurs when the breast tends to look as if it has descended on the chest wall after previous surgery,  whether the surgery involved implants, a lift, or a reduction.  In the case of “bottomed out” implants,  sutures can often be placed in the lower pole of the breast to re-elevate the breast on the chest wall.  This is called a capsullorraphy and can achieve excellent tresults in the correction of “bottomed-out implants.

Best Way to Fix Bottomed out Breast Implant?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Best Way to Fix Bottomed out Breast Implant? Wat at 6-9 months and then perform a caspuslorrhaphy. Slight overcorrectionis necessary and support in the post-operative period.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Remedy for Bottomed out Breast implant

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Surgery is the only effective remedy. Revision surgery is almost always more complex than breast augmentation. Correction techniques vary based on your plastic surgeon’s experience and skill sets. Always choose a board certified plastic surgeon with expensive revision experience as even in the best of hands recurrence is frequent especially if larger implants are used. Repair techniques include some of the following techniques and recommendations:
  1. Textured implants (“Velcro effect”)
  2. Use of Smaller Implants
  3. Maximum Submuscular Position (not just the pectoralis major but abdominis rectus below and serratus anterior on the side)
  4. Capsulorrhaphy (tightening the pocket by sewing in-folded capsular tissue together)
  5. Use of Biologic fabrics and other materials such as Acellular Dermal Matrix, “ADM” Alloderm, Strattice, “Silk” and others that can be used to reinforce the bottom of the pocket.
  6. Change of position of implant to a new pocket location “neo pectoral pocket”
  7. Internal Ryan Procedure (sutures binding the inferior mammary fold to stronger underlying tissues (e.g. fascial, periosteal)
  8. Removal of Implants and replacement of volume using your own fat (Fat Transfer).

You might also like...

The bottom is not "out".

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

 In my opinion the bottoming out is when a significant portion of the implant sits in the lower portion of the breast creating an unaesthetic breast.  Looking at your picture it appears to me that the pockets may have slightly different dimensions producing two different breast shapes.  Both are acceptable individually.  You may need to decide which breast shape you prefer and match the other to that shape.  I would heed the advice of your surgeon to wait. Continue follow up with your surgeon.   There may be some more changes in shape.  

Dr. ES

Revision breast augmentation in Manhattan.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}


1) "Bottoming out" is a very specific deformity, and you don't have it. You do have significant asymmetry, though.

2) Your right breast looks larger, the right nipple is higher. and the fold under your right breast is lower. I would wait a few months, to make sure things are not changing, and then a revision breast augmentation should make you better.

3) Each revision is individual. Your surgeon needs to make a specific plan for your anatomy.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Best Way to Fix Bottomed out Breast Implant

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question. Your still in your recovery period from your surgery.  I would wait 6 months.  Use underwire bra.  If there is a significant difference in the inframammary folds, after this time, then you may need a revision. A revison would entail a caspuslorrhaphy and internal sutures to elevated and fixate the inframmary fold.   Discuss your concerns with your Board Certified Plastic Surgeon. Best wishes.

Fixing bottomed out breasts

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It does look as though your breast has bottomed out. It is necessary to heal for 4-6 months so that the tissues are healed and can handle the stitching needed to close off the extra pocket and move the implant back up.

How to fix bottoming out implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In order to repair bottoming out implants I will either close the pocket with internal sutures or restore and support the breast pocket using Strattice™ Reconstructive Tissue Matrix (sterile tissue derived from porcine skin), which is designed to support tissue regeneration. Strattice secures the implant location to reduce future migration problems. After your breast implants bottoming out repair surgery, your breasts will look elevated and symmetrical again. 

I have attached a link to more information about bottoming out implants for you to review. Good luck!

Jimmy S. Firouz, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 18 reviews

Bottoming Out and What to Do

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
It’s not unusual for patients to note implant malposition in the immediate post-operative period. In many cases, this is transient and related to swelling and muscle spasm. For this reason, revisional surgery should be delayed for at least 6 months following surgery. Prior to this time, corrective surgery involves trying to hit a moving target because wound healing is such a dynamic process. At six months, muscle spasm, skin tightening, swelling and inflammation associated with wound healing have improved sufficiently to obtain a good result.
Your right breast implant has drifted downward, but it’s only been two months since your surgery; for this reason, revisional surgery should be delayed for an additional four months. At that time, if the problem is still present, corrective surgery can be undertaken. Correction would require a procedure known as capsuloraphy. This procedure involves placing sutures in the lower breast pocket to raise the height of the inframammary fold. The procedure provides correction of the problem and is associated with high satisfaction rates.
If you’re concerned about implant malposition, it’s important to consult your plastic surgeon. Your surgeon should be able to formulate a plan that addresses your concerns.

Not uncommon

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

"Bottoming out" can occur for several reasons, not unusual with heavier saline implants, especially if the fold beneath your breast was adjusted lower at surgery to accomodate the implant. The best approach is to wait at least 6-9 months to allow the capsular tissue to mature/strengthen to allow permanent suture repair of those tissues to hold the implant up into the proper position with less chance of it reoccuring.

The fix is fairly easy and predictable but does require a trip to the operating room again.

Stay in touch with your plastic surgeon regarding possible revision. 

David J. Levens, MD
Coral Springs Plastic Surgeon
5.0 out of 5 stars 79 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.