Are my Breast Implants Bottoming Out?

I had breast implants put in 2 years ago- silicone gel & over muscle. I also had a donut pexy lift. At first my implants were high. it feels like my implants are heavy and pulling on my skin all the time, especially when I am not wearing a bra. I can feel the implant at the bottom of my breasts.

Doctor Answers 10

This is a normal after above th muscle implants

You had moderate sagging before surgery and your doctor tried to give you the lift with minimal incision. The Donut lift gives less scar but does not lift the breast well. Placement of the implants above the muscle did not help since the creation of the pocket separated breast tissue from the chest wall and caused more sagging. From the picture, I would recommend full breast lift with possible repositioning the implants under the muscle.

New Orleans Plastic Surgeon
4.8 out of 5 stars 122 reviews

PHOTOS: Are my Breast Implants Bottoming Out? No, its jsut ptosis.

Are my Breast Implants Bottoming Out? Your photos show that you are experiencing sagging (ptosis). This would best be treated with another lift and downsizing, in my opinon

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Bottoming out breasts

It depends on what is meant by the term "bottoming". Usually this term is reserved for a stretching or lowering of the inframammary crease but it can also refer to stretching of the entire lower pole of the breast and the implant along with it which is what is happening here. 

Although I would not intervene yet because the situation may stabilize and the implant/breast does not appear too low relative to the crease, several points need to me made. 

I don't feel that the size or type of implant has anything definite to do with this problem. I don't feel that putting the implant above or below the pectoralis muscle makes a difference in the lower pole of the breast. A periareolar "lift" does not truly lift the breast nor will it solve this problem. Breast sag because of tissue factors and in spite of one surgeon's answer about "tightening", there is no way to tighten the tissues and prevent sagging. A true lift (mastopexy) is more like taking a dart in clothing and requires a seam-like vertical incision in the lower pole of the breast (but not the inframammary crease incision). 

At some point a true mastopexy will likely need to be done with or without changing the implant but I wouldn't recommend it yet. It's also possible that the 4th generation (form-stable) gel implants will have some impact on this issue. These are not currently available in the US and most US surgeons have little experience with them. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Breast implants

It looks like you may need a lift to raise the implants up and tighten the skin envelope.  Feeling the implants in the lower pole is common.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

breast implants bottoming out

I would not say "bottoming out" but you are having drifting inferiorly of the implant. I would recommend a full lift to achieve the higher appearance you desire.

From MIAMI Dr. B

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Laxity in breasts after augmentation

We do not have the benefit of having examined you prior to your surgery but it appears you would have benefited from a more aggressive breast lift and implants placed partially under the chest muscle. This does not guarantee that the lower breast tissue will not stretch but proper implant selection and more formal breast lift would provide you with a hopefully longer lasting result.

Dr Edwards

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 35 reviews

Rock-in-Sock deformity results from large implants above the muscle

You've got the classic stigmata of a subglandular breast augmentation losing the battle against gravity and poor skin quality. The weight of your implant is overpowering the meager support of your breast tissues. Also, your areolar closure form your breast lift appears dilated with a thickened scar. Based on this photo- I'd recommend implant removal, replacement under the muscle, and a full breast lift. 

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 65 reviews

Breasts Sagging, Not Bottoming Out

From your picture, it does not appear that you are bottoming-out at all.  Instead, you are developing more ptosis, or sagging, of the breasts.  Over time, if the implant is above the muscle and someone has only undergone a benelli ( doughnut) mastopexy, the implants can puill too much on the tissues and stretch everything out again.  It appears that you need a lift revision - probably one that also includes a vertical and possible horizontal extension of the scar to get a more powerful lift.  I hope this helps.

Christopher V. Pelletiere, MD
Barrington Plastic Surgeon
4.8 out of 5 stars 73 reviews

Needs a breast lift

The problem with placeing moderately large implants over the muscle is that they will NOT lift you and will quickly drift down into a ball-in-sock look like you have if your skin elasticity is poor.  In my opinion, you would have been better off under the muscle and you need a full lift to correct the excess skin in the lower pole.  

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Breasts+Large implants OVER the muscles = Quick Sagging of breasts

You are right. You DO have sagging breasts. The reason? - NO ONE wins the battle with gravity and aging. Putting large implants over the muscle and hoping the breasts would stay in place by then doing an ineffectual "donut pexy" (whose only contribution were the gathering around the areola and ripples) is a prescription for faster breast sagging and thinning of the lower breast tissue.  You ARE right. Your "implants are heavy and pulling on my skin all the time".

If you like the size of your breasts, your options now are : do nothing and wear bra support more frequently to slow the process or have a Breast Lift (Mastopexy) which would involve a lollipop scar. Other, more complicated options are available if you wanted smaller breasts and the implants exchanged.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 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.