Breast augmentation - what is the risk of bottoming out if I get implants? (Photo)

Based on the photos and the provided information you are at risk for bottoming out. It appears you will have the best outcome from revising your lift to remove excess skin from the bottom of the breasts and adding an implant. Implants placed under the muscle have a few benefits to consider. They carry a lower incidence of capsular contracture, the muscle helps to support the implant, and the muscle acts as a camouflage to the upper portion of the implant. I've included a video I hope you find helpful.

Bottoming out occurs when an implant migrates below the native fold. This can occur if the anatomic structures are disrupted during augmentation or if an oversized implant attenuates the support over time.

With regards to your specific question, the risk is operator and implant dependent. Careful dissection during an IMF approach can ensure that the native fold is preserved. Appropriate implant selection is also essential.

While bottoming out is a risk, it is by no means something that is anticipated.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

You have bottoming out. The operation for you is breast implants and a secondary vertical lift to cinch the lower poles. Your nipples should not be raised at all. The implants can go either below or above muscle. The key is the secondary breast lift to tighten your lower poles. The implants need to be placed correctly to give you the upper pole volume you want, so you look great naked or in a bikini.

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Dear sgrmk,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery