I Think I Have Bottomed out a Little, Will my Breasts Continue to Drop?

Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.Bottoming out and Side Boobs Contributing Factors:Larger/Heavier ImplantsImplants placed above the pectoralis muscleChronically not wearing a bra when uprightOver dissection of the Implant PocketSmooth ImplantsLarge swings of weight including pregnancySkin and soft tissue laxity, loss of elasticity

"Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant.This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold. However, it is best to consult with your Plastic Surgeon to better confirm with an in-person exam.

As others have stated, it does look like you have "bottomed out."  At 2.5 months, your implants may descend even more going forward.  I would wear a supportive bra 24/7.  I think the Z bra is a good one.  I included a link to the website where you can order it.  I don't think exercise should make it worse, though you may want to avoid activities that are focused on the pectoralis muscles for now (such as bench press and push ups).  A revision will correct this.  The procedure is called a capsulorrhaphy or capsulopexy.  Good luck. 

In my opinion, your breasts will continue to drop until 6-9 months. In the meantime, I would wear a supprtive padded underwire bra to minimize distansion and help supoort closure of the lowe capsule.  

Dear 3886,Thank you for your post. I am very protective of my patients with augmentations who are runners. I recommend that they buy the athleta underwire sports bra with the front adjustable straps. My patients really like this bra for running and find that it holds them very stable. It is cupped instead of compressing the breasts together. Some patients use an additional regular sports bra on top of this for extra security. Some like it for everyday wear in the initial post-operative period. Using a regular sports bra that just compresses the breast together rather than cups that keep their shape can cause flattening of the breasts especially in the early post operative period and wearing a bra that doesn't have enough support, especially when running or any bouncing type activity, can cause bottoming out or stretching of the breasts. It does appear that you have bottoming out.  I would wear a good supportive bra like the athleta bra or another very supportive underwire bra at all times to prevent this from worsening.  This can be fixed but I would recommend going with a textured implant for better staying power and removal of the entire capsule so that the implant can have tissue ingrowth, otherwise, the texture is worthless.Best wishes,Pablo Prichard, MD

Thank you for the question and picture.

I do think that your implants are to low on the chest wall and may contain to move down with time.

One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).

Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. This is corrected by “raising” the inframammary fold using internal sutures. This is done after careful measurements are made from the areola to the “new” inframammary fold.

I would suggest in person consultation with board-certified plastic surgeons well-versed with revisionary breast surgery.

Best wishes.

“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.  Bottoming out may worsen with time, you should discuss the timing of correction with your surgeon.

Your concerns are validated. You do have bottoming out. You can tell not only by the fact that your implants are not centered underneath your breasts, but also because your incisions are higher than your fold. When the implants are too low, it makes your nipples appear higher. I recommend wearing a very supportive sports bra when exercising. It is difficult to say whether they will continue to bottom out more, but they will not improve on their own either. You will need revision surgery to address this.

Hope that helps and good luck!

Dr. Babak Dadvand

You may very well be bottoming out based upon this photo.  Your nipples do look a bit high.  Good luck with your visit with yoru surgeon.

You are right. You have bottomed out and the only way to slow or stop the process is to wear a well-fitted bra whenever upright and especially when exercising to prevent the jack hammer effect of the breasts bouncing up and down unsupported.

In my opinion which I am sure would be contested by some of my colleagues, your implants are a bit on the large side for your frame. If you insisted on this size I would have preferred to use silicone filled implants which are lighter than saline. I would have used an around the areola incision, not a breast fold incision. The inframammary incisions weaken the bottom shelf of the breast and makes bottoming out easier. As you can see in your pictures, the breast fold scars are no longer in the breast folds but have moved up on the breasts.

hope this helped.

Dr. Aldea