How can I prevent bottoming out?

Question

So i know getting too big of an implant is one of the cause for my BA to bottom out but i also heard its genetics. But im confused as to what that means, like does it mean im more prone to it if i have little breast tissue or ? Im 5'2 110 pounds and i will be getting implants either 265, 295, or 325cc's. Im an A right now and asian (so i have rly tight breast tissue). And whats the percentage rate overall for bottoming out?

Martin Jugenburg, MD · Answer

Bottoming out is
common when the inframammary fold is released and not firmly sealed and
reinforced.

A weak
inframammary fold will result in downward breast implant displacement once the
breast implant slips below the natural or surgically lowered inframammary
crease overtime.

Clinical signs:

·        
Bottomed out implants end up too low on the chest
wall with the inframammary scars travelling up onto the breast skin.

·        
The nipples will not only point upward, but also
be positioned higher on the breast mounds.

·        
There will be no pain, but you may notice thinning
of the skin at the bottom of the breast, which will allow you to more easily
feel the breast implant.

It is good to be
wearing supportive bras as this prevent further bottoming out. Supportive bras
will apply upward pressure to the fold at the bottom of the breast.

To correct “bottomed out” breasts, a surgeon would need to secure the
implant in an elevated position and then reinforce the implant capsule at the
bottom of the breast with a suture technique. There may be a need for Acellular
Dermal Matrix, a soft-tissue graft, in the repair. A smaller implant is often
advisable, if the original was too large. In fact, receiving an implant larger
than indicated by your breast characteristics and boundaries increases the risk
of malposition.

True prevention of bottoming out requires choosing implants that are
tailored to your breast anatomy and characteristics.

Your surgeon may use tissue-based planning to determine the implant
size. The planning takes into account the effects of implants on tissues over
time, risks of excessive stretch, excessive thinning, visible or palpable
implant edges, visible traction rippling, ptosis (sagging), and breast
tissue wasting.

To determine the final implant size, breast measurements such as breast
base width, breast skin stretch, and nipple-to-inframammary fold distance. The
combination of these measurements will help determined tissue coverage and the
required implant volume to optimally fill the breasts.

Please have an in-person consultation with a board-certified plastic
surgeon and share all your concerns, desires, motivations for the breast
augmentation surgery.

Hope this helps.

Gregory DeLange, MD · Answer

Bottoming out, which is also called pseudoptosis, is an unfortunate complication we occasionally see with breast implant surgery. It is secondary to the lower breast fold releasing and the implant then rests in an unnatural low position. It is either from poor quality of lower breast and muscle tissue, poor formation of the breast capsule, or over dissecton of the lower fold which allows the implant to drop too low. We quite often see it from implant patients who perform a lot of heavy chest exercises or movements such as burpees. It can be fixed with tightening the lower capsule but sometimes requires mesh placement for additonnal strength.

Farbod Esmailian, MD · Answer

From what you have described it is unlikely for you to bottom out given the implant sizes.  Quite frequently, bottoming out is seen when too large of an implant is placed and/or the inframammary tuck is disturbed.  Bottoming out can also be seen in patients with weaker and thinner tissues (genetics).  It is also believed that higher profile implants pose a greater risk of bottoming out and excessive lower pole stretch as they exert greater force on the tissues.This is why is very important to choose your surgeon carefully, you want him/her to be cautious and to provide you with a procedure that will last you and your body a long time free of complications.Hope that helps.

Joshua Cooper, MD, FACS · Answer

When we perform breast augmentations, we always place internal sutures sewn down to the muscle/fascia of the chest wall to recreate the infra-mammary fold.This definitely has prevented bottoming out in our hands. It's important that this be performed especially in breasts where the native infra-mammary fold needs to be lowered to accommodate a larger implant. Definitely discuss with your plastic surgeon how he/she prevents bottoming out from occurring.

Jerome Edelstein, MD · Answer

Hello,There is no reason to expect bottoming out considering the implants you have selected. As well, if you have chosen a qualified, experienced Plastic Surgeon, complications such as bottoming out should not be likely. Over dissecting the breast's natural crease when attempting to lower a breast fold can make the breast susceptible to bottoming out. Talk with your Plastic Surgeon about your concerns so that they can put your mind at ease.All the best

Shahram Salemy, MD, FACS · Answer

This is a good question-- bottoming out can certainly occur regardless of the patient, surgeon or implant, but in general if we select a reasonable sized implant the rates are quite low.  Your surgeon will give you a better sense of their concerns for this occurring in your particular case once they do a n exam and review your goals for the procedure.

Brent Moelleken, MD · Answer

Large sub pectoral implants are often doomed by anatomy.

Assuming the implants are correctly placed and the lower dissection is not overdone, there are certain anatomic facts that can't be avoided.  The upper border is the top of the pectoral is major muscle; the middle border is the sternum and the pectoral attachments.  So the only direction that a large implant has to go when the forces of the pectoralis muscle and gravity act is down... and out.

In some patients the tissues are strong and the implants relatively resist that tendency, but in many patients the implants bottom out.Many patients have redo surgery with various matrix materials or human allograft material.

I have redone many redo cases where various matrix materials were placed and failed.  The physics was the same, with or without the matrix material.  The redo surgery involved removal of the Strattice, redo of the internal pocket and, most importantly, placement of smaller implants, often with a higher profile than the original implants.

I always recommend to my patients to avoid very large implants for this reason:  the best way to prevent bottoming out is to design the surgery so it is less likely to occur in the first place.

Aldo Guerra, MD · Answer

Hi Bella. Complications cannot always be prevented, but we can try hard to reduce the risks by using knowledge and techniques. Smooth breast implants will slide and are more prone to bottoming out and having position problems. Perhaps you should consider using a textured breast implant which generates friction and reduces bottoming risks. Suturing the mammary fold into its normal position helps too. Watch the video below to see what I'm talking about performed on a real patient using form stable breast implants. Best regards, Dr. Aldo

Payman Danielpour, MD, FACS · Answer

Thank you for your question. It is hard to predict whether or not your breasts will bottom out or not but I believe that you are using appropriate size implants and that is the first and most important step in preventing complications, including bottoming out.

Malcolm A. Lesavoy, MD, FACS · Answer

From your description of your size and body/breast contour, it is very unlikely that you would bottom out after breast augmentation, unless your surgeon dissected the pocket for the implant too low.