Bottoming out 10 Weeks After Breast Augmentation?

I had breast implant surgery around 10 weeks ago, I believe they are begining to bottom out!? with a shirt and bra on they look fantastic, shape is good. But without my nipples are extremely high do not stay in any bras and I have to wear nipple covers because they pop out. On the left side there has always been a very faint line around the bottom curve looks like the implant fallen??

Doctor Answers 11

Bottoming out of a breast implant

There is no question that your implants have bottomed out.  This occurs due to lack of support of the breast implant.  There are many causes including over dissection of the pocket and violation of the inframammary crease, heavy implants can also cause the implant to descend.  As the implant drops it causes the nipple to point up.  To correct this problem you will need an inferior capsulopexy and resetting of the inframammary crease with several fold sutures.  

Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Breast implants that are bottoming out

BOTTOMING OUT is a condition where the implants have dropped lower than where they should be.

So how does a “bottomed out” breast look? They look exactly how yours look!

- The bottom of the breast is much fuller than ideal, with a long distance from nipple to lower breast fold.
- The upper half of the breast is empty
- With the implant dropping down, and because the nipple doesn’t physically move, the nipple is no longer central over the breast mound. Instead it ends up sitting too high on the breast mound and pointing upwards, and other than just looking odd this can cause practical problems with areolars visible above the upper end of a bra.

So before we look at what has potentially caused your bottoming out a basic surgical concept needs to be explained.

Surgically, when the implant is positioned the deep aspect of the wound is stitched to form a secure rigid internal support to hold the implant in position, like an internal bra. I close my wounds using three internal layers of stitching and this deepest layer is perhaps the most important.

So with this in mind, it follows that bottoming out can occur if this deep stitch layer is poorly performed, or not performed at all.
Or, if this deep stitch layer is not allowed to heal properly. For example, too much inappropriate physical activity too soon can potentially cause this layer to break down.

Other things that can contribute to bottoming out include:
- Implants placed too low to start with
- How heavy the implants are - heavier implants are more prone to dropping
- Smooth implants are more prone to dropping than textured
- Implants placed in front of the muscle are more prone to dropping compared to those under the muscle
- The quality of the person’s breast tissue and skin - breast tissue that’s soft and thin is less capable of supporting an implant
- Not wearing appropriate supportive bras to support the weight of your breast implants
- Or any combination of these issues

I would encourage you to see your surgeon early so that they can determine why this may have occurred, and commence plans to surgically remedy the situation. In the meantime you should wear a very well fitted supportive bra.

Eddy Dona, MBBS, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 81 reviews

Bottoming Out after Breast Augmentation

Bottoming Out after Breast Augmentation 
Yes you appear to be bottoming out. Therefore the appropriate treatment would be to reconstruct your inframammary crease in its original position (for example using an internal Ryan procedure). . Also helpful would be textured implants and placing them in a submuscular pocket to minimize re-bottoming out in my experience

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 159 reviews

Bottoming out when implants are in a sub pectoral position can be easily fixed by moving them to sub glandular

If the implants or in a sub muscular position it is possible that the vector of force created by engagement of the pectoralis muscle can create bottoming out. In this situation a simple fix is to move the implants to a sub glandular position.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

Bottoming out 10 Weeks After Breast Augmentation

From the photograph it does indeed look like you have bottomed out.   I would see my plastic surgeon to see what could be done.  It may be a good idea to wait 6 months before reevaluation and a decision to operate is made.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
4.8 out of 5 stars 110 reviews

Bottoming out

It's unfortunate but yes, your implants appear to have dropped too low. This can happen when the implant isn't positioned properly or the pockets aren't accurately made. You will most likely require another procedure to correct this. Please see your surgeon.

Ronald Levine, MD
Toronto Plastic Surgeon
4.6 out of 5 stars 24 reviews

Your Implants Suggest That Your Breasts Have Bottomed-Out Following Breast Augmentation

Review of your photographs; strongly suggest that your breasts are bottoming out following your breast augmentation. This problem appears to be worse on your left side than your right side. When this phenomenon occurs, corrective surgery is usually required to fix the problem.

There are several possible causes of this problem. Occasionally, over dissection of the inferior pocket may contribute to inferior migration of the implants. In most cases, wound healing biology is a significant factor. In some patients, inadequate capsule formation can result in lack of support of the implant. Over the course of time, the weight of the implants can result in stretching of the pocket and inferior displacement.

When this occurs, it’s necessary to perform a capsulorrhaphy to correct the problem. This involves raising the height of the inframammory fold and the breast pocket. Timing of the procedure is critical. It’s important to allow time for the capsule to mature. This increases the potential for success of the procedure.

In the interum, the use of a support bra with an underwire will minimize further inferior migration. It’s important that you see your plastic surgeon for his recommendations. Although this problem occasionally occurs with breast augmentation, it fortunately can be fixed.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Implants appear to have bottomed out (photo/pics)

It appears that your implants have bottomed out. This will likely require revision) in order to achieve a long term solution. I would discuss the timing of the surgery with your surgeon who may have a diffferent recommendation

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 reviews

Bottoming Out 10 Weeks After Breast Augmentation

"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. Bottoming Out typically requires a revision procedure to correct it.
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.

It is usually best to wait 6 to 12 months depending on the reason for #revision.  You can learn more about the options suitable for your situation by consulting in-person with your board-certified plastic surgeon.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 110 reviews

Bottoming out implants?

Thank you for your question and pictures. I do not think your implants are "bottoming out" It looks like they are too large and placed too low from the onset. This is usually the result of over dissection of the implant pocket and using implants that are too large for a patients frame. Bottoming out, refers to the process of the implant gradually stretching out the lower pole of the breast over time, and resulting in a picture similar to yours. However , this does not happen in ten weeks! You should see your surgeon and discuss your concerns. Good luck.

Steven L. Ringler, MD, FACS
Grand Rapids Plastic Surgeon
4.9 out of 5 stars 70 reviews

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.