How Can You Tell if Your Breast Implants Bottom Out?

Dear Doctors, I've had a slight concern about my nipple and whether it sits slightly high on my breast mound. It has been 6 months post op. I'd like to have your professional opinion on whether you think my breast implants have bottomed out.

Can you tell just by looking at the implants whether they are bottoming out, or are there other considerations? How do you know when it is time to call your surgeon?

Doctor Answers 18

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.

Atlanta Plastic Surgeon
4.7 out of 5 stars 34 reviews

When to call the surgeon

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.

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Inquiring minds want to know

Dear Inquirer,

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 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!

Kenneth R. Francis, MD, FACS
Manhattan Plastic Surgeon
4.5 out of 5 stars 44 reviews

Yours is borderline

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.

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

How To Tell If Breast Implants Bottom Out

If you believe you have a complication, the first thing you should do is see your doctor and have them examine you.

Imagine drawing a horizontal line across your nipple. Above that line is referred to as the “upper pole” of the breast, and below that line is the “lower pole”.

A round implant should sit evenly within the lower and upper pole, so that the nipple is at the center of the implant. Bottoming out is a complication in which the implant falls below the inframammary fold (breast crease), and hence, more of the implant is in the lower pole.

This will cause the implant to look low and possibly, cause the nipples to point up.

Have your physician examine you to determine whether your implants have bottomed out or whether their placement is within normal bounds. Your doctor will measure the distance from your breast crease to your nipple to make this determination.

I hope that answers your question on implants bottoming out. It’s great that you’re doing this research. I always say that the best patients are informed patients.

You might also want to research your options for breast implants. Choosing the right implant is the number one concern among women considering breast augmentation. Did you know, there’s actually a way to select a implant shape, size, and profile that is perfect for you?

A term that I use with my patients for the perfect implant is the “Pony Implant”.

So what do I mean by “perfect”? Well, a Pony Implant has three qualities to it. First, the implant meets your beauty goals. For example, you want to your breasts to look fuller while still appearing natural.

Second, when you chose your Pony Implant, you walk out of your consultation 100% confident that you’ve chosen the right shape and size for you. In other words, you won’t be second guessing your decision, and you won’t be afraid of having gone too big or too small.

And third, after your procedure, you are thrilled with your results, and say, "I’m so happy. This is exactly what I wanted!"

That’s the Pony Implant. And the great news is that there is a simple process to go about finding yours.

This issue of selecting the right implant is so important when it comes to patient satisfaction or dissatisfaction that, again, I really encourage you to learn more about it.

Thank you for reading and best of luck on your journey!

William Rahal, MD
Beverly Hills Physician
5.0 out of 5 stars 32 reviews

Are you bottoming out?

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:
  1. Larger/Heavier Implants
  2. Implants placed above the pectoralis muscle
  3. Chronically not wearing a bra when upright
  4. Over dissection of the Implant Pocket
  5. Smooth Implants
  6. Large swings of weight including pregnancy
  7. Skin and soft tissue laxity, loss of elasticity

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 150 reviews

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.

Gary Lawton, MD, FACS
San Antonio Plastic Surgeon
4.9 out of 5 stars 133 reviews

What did you start with?

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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 79 reviews

Yes, but mild

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!

York Jay Yates, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 169 reviews

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?

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 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.