Bottoming Out?

I had my BA in August of last year and had 270cc filled to 300. I am 5'4 and my weight is 105. I have lost 4 pounds since my ba and I don't know if my implant is lowering because my skin is too thin. I am having trouble wearing bandeau bikinis because I can't cover my areola because it's too high! I started out as a 32A and my doctor told me not to massage my breasts after the operation. I think the lowering of my implants is making them look small again. Am I over reacting?

Doctor Answers 9

Correcting bottoming out implants

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You are correct this is a bottoming out of the implant.  The ideal position of the implant is for the center of the implant to be directly behind the center of the nipple.  Your implant is too low and has caused the nipple to point upward.  The distance between the nipple and the inframammary crease has stretched due to the weight of the implant.  There are several surgical methods and techniques to correct this problem.  

Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Bottoming out

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Your implants have bottomed out.  This can occur over time with large implants that place tension on the inframammary fold or from excessive dissection of the fold during the original surgery.   Since you are a year out from surgery and have a well formed capsule at this point, correction would involve doing a capsulotomy in the upper pole to allow upper positioning of the implant and closing the capsule in the lower pole to lift the IMF.  

Bottoming Out? #breastimplants

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Yes you are bottomed out. You either need to have a pocket revision to tighten the capsule and hold the implants higher and if that is not good enough you likely will need a lift to tighten up the stretched out skin from the nipple to the breast fold. The nipples are too high on the breast mound. Were you pretty small to start with? If so, this can happen where you put implants in to a very small breast and then the lower pole tissue stretches a lot especially if they are high profile implants. 

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 54 reviews

Bottoming out?

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Hello and thanks for your post. It certainly looks like the breast implant is too low and that more of the implant volume remains in the lower portions of the breast while the upper pole is relatively empty. Your breasts are off balance, in other words. This is a fairly common result of breast surgery, but it can be improved by reducing the space in the lower breast and repositioning the implant higher. Seek a consult with a board certified surgeon for all options. Best wishes.

Aldo Guerra, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 215 reviews

Breast implant bottoming out

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Your implants appear to be bottoming out and that is what is causing the issues in your bikini.  I would contact your surgeon for a follow up exam.  Good luck.

Too low

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Your implants have bottomed out. This can be common with incisions placed at the fold especially if the incision is place lower than the fold and the correct sutures not placed. Would recommend seeing your doctor to correct this deformity.

Typical troubles with a low implant

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Your implant is low or 'bottomed out' as seen in your photo. The implant should stay centered in the breast under the nipple with the point of projection at the level of the nipple, not below. The present situation makes you susceptable to wardrobe malfunctions and repair might be best.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Bottoming Out?

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There are a number of conditions that are sometimes called bottoming out, usually referring to an implant that has descended on the chest wall to a point below the original breast fold resulting in an appearance that is too low. 

These implants appear to be too low. The nipples should be centered on the point of maximum projection, and that is clearly not the case here. I wonder if your no massage instructions were the usual for your surgeon, or if there was concern early on about the implant position. 

There is a fix, but it requires surgery, and the surgery should be done through a breast fold incision to reset the bottom of the implant pocket even with the original breast fold. That should correct the swimsuit problem, and restore the apparent size to how it appeared right after surgery.

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

""Bottoming out" of the breasts after augmentation is more likely after a sub muscular placement.

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Too much volume below the horizontal pole of the breast is referred to as "bottoming out". When the implant is below the pectoralis muscle, that muscle when it is engaged generates a vector of force that pushes the implant down and away. Over time this can create a volume maldistribution. The history does not say whether or not the implants are the pectoralis muscle. If they are, replacement about the pectoralis muscle is a therapeutic option.

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.