The distance between the bottom of the areola and the inframammary fold determines if an implant is "bottoming out".
In a "C" cup breast, the distance from the areola to the crease is about 6 cm (3 inches), slightly more for "D" cup. If the distance in 2 cm or so longer, the volume of the breast will appear well below the horizontal axis. This is most commonly seen in submuscular implants where the vector of the pectoralis muscle pushing on the implant stretches the capsule and creates this problem.
The time to call the surgeon is anytime after surgery and you have concerns.
As Dr. Baxter points out there is some amount of judgement based on the pictures you're presenting. It is difficult to say specifically without seeing your pre-operative pictures as well.
I would say that your inferior pole (the under portion of your breasts) seems a little full. Whether the average person would find this unattractive may be a point of discussion.
As always - the best way to address concerns post-operatively are to see your treating plastic surgeon or make an appointment to see a board certified plastic surgeon.
I hope this helps.
Inquiring minds want to know
There is a wide range of results from breast augmentation surgery. Yours is certainly well within acceptable and trending toward good, if not very good. The real self.com question is do you like it? If you are displeased with the result discuss it with your plastic surgeon. He/she can explain your options and any further consequences that you may incur. Good luck!
Larger fuller implants are heavier and more prone to bottom out. Yours look like they might have a slight downward displacement but not drastically so. If they were put in through the crease, you would see your scar riding up higher onto the lower pole of the breast. This can be a tipoff of bottoming out. Unless you are unhappy with your current result, there is no need to do anything because yours is mild.
You should make an appointment with your surgeon for an in person consultation. If you are bottoming out then here is some information which could help you.
Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.
Bottoming out and Side Boobs Contributing Factors:
- Larger/Heavier Implants
- Implants placed above the pectoralis muscle
- Chronically not wearing a bra when upright
- Over dissection of the Implant Pocket
- Smooth Implants
- Large swings of weight including pregnancy
- Skin and soft tissue laxity, loss of elasticity
Asymmetry in preoperative nipple position
You may have a little bottoming out, but it is really just the relative difference in nipple position from left to right. Breasts are naturally asymmetric. I think you outcome is good and you should not address it surgically.
Your result is certainly within the range of normal.
My question is what did you start with? Was this the general appearance of your breast but only smaller?
IF the answer if yes then, I would not be concerned at all.
IF the answer is no, then the next question I would ask is if it has gotten worse over the past 2-3 months.
IF it has gotten worse, I would be concerned and consult with your plastic surgeon
IF it has been stable, I would make sure that the vast majority of bras you wear are supportive bras (padded underwire) and you may want to wear them at night to prevent further aggravation of the lower pole expansion.
In the photo you have submitted, the right shoulder is a little higher than the left yet the right implant is sitting a little lower. The right implant also seems to have bottomed out a little more than the left. It may certainly be the camera angle. That being said, the asymmetry is fairly mild and the degree of bottoming out is mild as well. My opinion (based on a single photo alone) would be to revise it only if it is very bothersome to you. Sometimes the enemy of good is better!
Not technically bottoming out...
Although your nipples appear north of the equator of the implant or mound of your breast, whether or not this is attractive is a matter of opinion and taste.Some patients prefers and some might think the implants are too low (nipple too high). Bottoming out usually refers to a long-term effect of inferior displacement, loosening,or sagging to the bottom part of the breast. This is also a term we use in breasts without implants after a reduction or lift where the breast tissues loosens and falls too far below the nipple.
You might discuss this with your surgeon as to whether the position of the implant is in the location he and you intended them to be, or if are they lower than intended. Sometimes the relationship between the implant, the nipple and the bottom of the breast is hard to accurately predict because it is a dynamic operation of sorts where things move around a bit and tissue stretch.
In the end it is not so important if you call this bottoming out, displacement, or malposition. The question is: is it bothering you enough to want to do something about it?
Breast implants bottoming out - A matter of opinion
In general, bottoming out is when you see more breast below the nipple than above, taking into account that too much fullness in the top portion is not a natural look.
If you imagine the outline of the implant forming a circle, ideally the nipple would be in the middle most of the time. From your pictures, some would deem them to to be attractive, others would call it bottoming out.
My sense is that there is some bottoming out, though whether it is enough to justify additional surgery depends upon your preferences.