Does Wearing a Bra Protect Breast Implants from Bottoming Out?

Hi there-
While I do believe that a good support bra is important after augmentation surgery (especially when implants are placed under the chest muscles), I don't think that the bottomed-out appearance, where there appears to be excessive skin showing between the fold under the breast and the nipple, can be prevented by using one. The primary cause of a bottomed out appearance would be violation or lowering of the inframammary fold structures (either deliberately or inadvertently) at the time of surgery.
In a minority of patients, an initially lovely result can over time appear more bottom heavy, indicating a possible need for a breast lift, but a truly bottomed out appearance soon after surgery would most likely be due to technique and not the bra.

There doesn’t appear to be a consensus amongst plastic
surgeons regarding the use of bras following breast augmentation surgery. Many
plastic surgeons tell their patients it doesn’t make a difference while others
tell their patients that bras are an absolute necessity in the post-operative
period. Unfortunately, there are no scientific studies that clarify this issue.A complex relationship exists between breast tissue,
wound healing biology, breast implants, and gravity in patients who have
undergone breast augmentation surgery. It makes sense that breast implants can
exert significant downward pressure on the soft tissue of the breasts. Over the
course of time, this might lead to soft tissue stretching and bottoming out of
breast implants. For this reason, we feel it’s appropriate to wear a bra
for support following breast augmentation surgery. This is especially true when
larger implants have been used and placed on top of the pectoralis muscles. It’s important to realize that each patient’s situation
is unique. For this reason, postoperative care should be individualized. Under
these circumstances, it’s appropriate that you discuss this issue with your
plastic surgeon. Your surgeon should be able to formulate a treatment plan
that’s appropriate for you.

My experience after nearly 3 decades of observation is that in many cases bra wear most days in general do help prevention of bottoming out over the life time of the implant. This applies to all implants and especially with smooth implants that are place over the muscle (subglandular). They of course would not be of benefit at night as gravity and implant weight is not at work pulling the implant downward.

 

Wearing a bra can help support the skin envelope holding up the implant. So, I would recommend wearing one as much as you can during the day. Also, working out may stress the implants and cause the skin to stretch out faster. Therefore, make sure you have excellent bra support while doing any aerobic activity.

I do not necessarily believe that bras prevent bottoming out but when I perform a repair of a breast that has bottomed out or repair a breast implant that falls to the side, I will recommend that patients wear a bra 24/7 to support and reinforce the capsulorrhaphy for a minimum of 3-6 weeks

Bra's after breast augmentation generally speaking are for support. They help support the weight of the implant to offload the newly operated breast tissue. They can support bandages in place, if they were used. They support the patient emotionally so that they feel that their newly enhanced breasts are stabilized and seated motionless where they were assigned.The operation is what places the bra in the correct position, not 'medical grade' undergarments. The patient's tissue response and the precision of the surgery are what count. Just like the implants can't be relifted by a brassiere, they also can't be dropped by a band (another medical grade garment commonly used after surgery). Massaging can help soften a scar and position the implant more favorably but for the most part, the masterpiece was created during surgery. That's why we don't leave the OR until they're picture perfect.A tincture of time is a good prescription that can help implants drop, sink, settle, soften, shrink, and all kinds of southbound transformations .. but even time can't reverse bottoming out (no matter how hard we wait, hope and stare visit after visit). Bottoming out will not correct with tape, walking on your hands, a bustier or even the above mentioned tincture of time. Sorry, but only a quick visit back to the OR can fix that. I've had to do this on rare ocassion and it has worked out quite well so don't lose hope for those of you that read this with bottomed out implants.This being said, most of us use bra's on our patients after surgery (sometimes). I'll finish the case, look at the result and dictate "No bra". Others, it'll be "No under wire bra". Typically, it's "Bra for 6 weeks". Regardless of the instructions that I dictate at the end of every breast augmentation, most patients come back on post op day 7 with a smile and their bra neatly folded in a ziplock and ask "did you want me to wear this?" .. and they're fine.

Dear Liezle,Thank you for your post. I am very protective of my patients with augmentations or lifts 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. Non-runners have less of a concern, but if the implants are big enough, gravity will have an eventual effect, so daily bra wear is recommended as well.Best wishes,Pablo Prichard, MD

Yes - a bra will help prevent your implants from "bottoming out". The main issue is your choice of implant size. If you chose very large implants, they will have more of a chance of dropping than moderate sized implants. A bra will help with either implant, as the elastic support of the bra will prevent the skin from feeling all of the stretch caused by gravity and the implants.

In most cases a bra or any other external garment will not make much difference in the final outcome. The quality of the patent's tissue is the most important feature followed by the size of the implant. Too large of an implant in a patient with poor tissue quality will eventually lead to an implant that bottoms out.

Bras are meant for comfort and resist sheer gravity. It will not stop them from drooping, BUT the more you protect them gravity, stretching and bouncing, the longer it would take gravity and aging to bring about dropping.