Bottoming out - what happens if left untreated?

Question

Hello , After BA/BL from a couple years ago..I am bottoming out. What happens if you leave bottoming out untreated? I'm planning to get pregnant again and wonder if it will be ok to leave it like now for now? If I were to do a revision before then, would pregnancy affect it ? What would you advise? Also, would bottoming-out be affected by weightlifting?Or can I limit to do Lower-body only weightlifting ? Is there a bra style or any other recommendations to minimize bottoming-out? Thank you

Krishna Vyas, MD, PhD, MHS · Answer

If left untreated, bottoming out can lead to a further degradation of the breast shape, with the implants continuing to drop below the natural breast fold (inframammary line). This can cause the breasts to look overly saggy or lose their youthful, lifted appearance. In some cases, it can also result in the implants becoming more visible or leading to asymmetry.
Pregnancy: Since you plan to get pregnant again, it’s generally advised to wait until after you've finished breastfeeding and have had all the children you plan to have before undergoing revision surgery. Pregnancy and breastfeeding can significantly affect breast shape due to hormonal changes, which might further alter the results of any corrective surgery. Revising the implants or performing a lift during or shortly before pregnancy may lead to unsatisfactory results due to the changes your body undergoes during pregnancy.
Supportive Bras: Wearing a supportive bra, especially during physical activity, can help minimize the visual effects of bottoming out and offer some support to the breast tissue. However, this won't reverse the condition; it’s more about managing the appearance in the short term.
In conclusion, it might be best to wait until after pregnancy and breastfeeding before considering revision surgery for bottoming out. Discussing your specific concerns with an experienced plastic surgeon will help you understand the best course of action for your situation.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Irena Karanetz, MD · Answer

Hello,
Thank you for the question. 
Bottoming out can often happen after breast lift with implants, especially with larger size implants.
If you are planning on getting pregnant/breastfeeding in the near future, I would wait for revision breast surgery until afterwards, because the breast shape changes with hormones and breastfeeding.
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon to further discuss your options, concerns and expectations. 
I hope this helps.Best, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Gary M. Horndeski, MD · Answer

Bottoming out occurred because the mechanical strength of the skin envelope does not have the satisfactory strength to hold up the breast implants up. It will continue to fall inferior and laterally. If your implants are retro-pectoral then the muscle will cause them to extrude inferior and laterally. You may need explantation and a possible lift, More information and photographs are needed to give you a more accurate answer.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear goals22,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

Wait until you have had all the children you want before doing a lift. Bottoming out is usually from an implant that is too large and heavy for your frame and your tissue cannot support the weight.  Occasionally, it can have for other reasons. continue to wear a good supporting bra during the day, especially when you are exercising.

David Mattos, MD · Answer

Those are all great questions. The good news is that you do not have to do anything. It is not harmful, and bottoming out to some extent after surgery is always expected. Some people bottom out more, and some of it has to do with tissue quality. If you're thinking of getting pregnant, I would not recommend surgery before pregnancy, as pregnancy is highly likely to impact your outcome. Once you have your kids and finish breastfeeding (if you choose to go that route), then you should meet with a plastic surgeon to consider your options. That way the result will last much longer. Good luck!

Jason Pozner, MD · Answer

I would leave alone if you are planning another pregnancy in the short term. If revised sooner pregnancy should not affect the repair but sometimes pregnancy with or without breast feeding causes shape issues and you may want that corrected. Weightlifting may exacerbate botttoming out but I would just continue doing what you want and just repair later after pregnancy.

Bottoming out - what happens if left untreated?

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