How Can You Tell if Your Breast Implants Bottom 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.

"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.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. However, it is best to consult with your Plastic Surgeon to better confirm with an in-person exam.

Thank you for sharing your picture and question. Upon reviewing your picture it appears that your implants are slightly bottoming out. At this point, I recommend going back to your surgeon for an in-person evaluation so he can better assess your bottoming out. As far as bottoming out surgery goes, in order to repair bottoming out implants I will either close the pocket with internal sutures or restore and support the breast pocket using Strattice™ Reconstructive Tissue Matrix (sterile tissue derived from porcine skin), which is designed to support tissue regeneration. Strattice secures the implant location to reduce future migration problems. After your breast implants bottoming out repair surgery, your breasts will look elevated and symmetrical again.I have attached a link to more information about bottoming out implants for you to review. Good luck!

Thank you for your question. This condition is a form of Implant migration. Although, it can be seen with all types of augmentation. It is more common with violation of natural mammary crease of the breast and/or too large of an implant. Hope this helped, best of luck!Dhaval M. PatelDouble board certifiedPlastic surgeon Hoffman EstatesBarringtonOakbrookChicago

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 ImplantsImplants placed above the pectoralis muscleChronically not wearing a bra when uprightOver dissection of the Implant PocketSmooth ImplantsLarge swings of weight including pregnancySkin and soft tissue laxity, loss of elasticity#bottomingout#breastaugmentation

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.

Overall, I believe most
people would consider the results of your breast augmentation surgery to be
excellent. There appears to be minimal settling of your implants and minor
asymmetry, but these changes are within the normal acceptable range and don’t
justify surgical revision.

 

         Evaluation of your
pre-operative photos may demonstrate baseline asymmetry that was present prior
to surgery. If you have anxiety about your situation, consultation with your
surgeon would be appropriate.

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!

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.