Breasts Feel Heavy and Low Without a Bra - Am I Bottoming Out?

I had a breast augmentation 1 year ago. My right breast never dropped like it was supposed to so 6 months later i had a capsulotomy to make it lower.. now 1 year later the right breast is getting really low and the left breast is following it too . I frequently have pains n discomfort when I dont have a bra on. But i feel like my implants are way too small to be bottoming out, they are 350 cc high profile silicone gel implants. Im 5'6 120 lbs...

Doctor Answers 6

Bottoming out and solutions

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You probably have undesirable lateral inferior stretchning that is very common with dual plane placement.  Placing breast implants under the muscle creates a few aesthetic problems. If you look at your picture, your breasts are too far apart at midline to have a natural appearance.  any time your arm moves this appearance will widen and worsen.  This is the reult of releasing the inferior portion of the pectoralis major muscle.  The more superior origins will not allow the implant to sit in a natural place and the continual forces of the muscle constantly push the implant down and out.  When this is combined with excessive undermining of the inframammary fold, the deformity that you are seeing results and continues to progress.  This is a very common finding with submuscular placement.  To understand these forces better, stand in front of a mirror topless, put your hands on your hips and push down onto your hip bones firmly.  You will see both breasts move down and out.  these forces over time always cause lowering, lateral displacement, thinning of the breast tissue and stretching of the skin.  This is the reason that I use a unique technique in my practice called 'cold-subfascial augmentation.' THis technique leaves the muscle alone and out of the equation but should not be confused with 'above the muscle' which I would also not recommend.  The cold-subfascial augmentation harnesses the strong structural power of the pectoral fascia to create a truly natural breast shape and act as a living structurally sound brassiere inside the breast protecting the breast from the pressure of the implant and forces of gravity.

I have seen many patients with identical problems to the one you present and in my opinion there is only one good solution- changing placement to a new cold-subfascial plane. I hope this helps!All the best,

Rian Maercks M.D.

Breast implants one year post op.

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This is difficult to assess without photos or a personal consultation.  Since you are one year post op, you should schedule an exam with your surgeon. 

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Repair of breast augmentation procedure

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There is hope.  Many plastic surgeons are specially trained to use AlloDerm or Stratice.  This has changed the game.  Most breast implant problems can be solved by using these products.  Keep in mind the products are expensive.  The results are worth it.  Consider seeing a plastic surgeon who has experience using AlloDerm and Stratice.  

Jay H. Ross, MD, FACS
Palm Harbor Plastic Surgeon

Bottoming out

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The fact that you had a capsulotomy to lower your implants may have caused the lower pole of your breast to weakened and indeed this may cause bottoming out. In general, we don't see bottoming out following primary breast augmentation and not within a few years. Bottoming out though is noted following breast lift and implant procedures as the lower pole is weekened by surgery.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 106 reviews

Breast implants bottoming out

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There is no way to know if you are bottoming out or what should/could be done for that without a photo and a more detailed history (are the implants above or below the muscle). Although bottoming out is more likely with larger implants, above 350 to 400cc, it can happen with smaller implants. Bottoming out is related to implant size, how long the implants have been in place and the specific measures taken at surgery to place the implant.

Aaron Stone, MD
Los Angeles Plastic Surgeon

"Bottoming Out" vs "Rock in a sock"

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Dear Baltimore8181,

Photos would be very helpful in answering your question. Knowing if you had a subglandular or submuscular placement is also important. Based solely on the information at hand, it sounds like you have had a subglandular placement because it is very unusual to have capsular contracture with a submuscular placement. 

Bottoming out occurs when the implant starts to descend below the breast fold. It is an issue of the implant being malpositioned (ie. too low) with respect to the rest of the natural breast. The typical outcome is that the nipples look too high.

I do not think you have bottoming out. What you are describing sounds like subglandular implants that are causing the skin to stretch and the entire breast to descend (ie breast ptosis (drooping)). This is sometimes referred to as a 'rock in a sock' deformity, as the weight of the implant stretches the breast tissue, bringing the entire breast downwards (and in your words 'getting really low'). This can occur with any size implant and would not be unusual with a 350 cc implant in the subglandular plane. Pain can be a symptom from heavy ptotic breasts, but it is not a typical complaint with bottoming out. The fact that your pain is relieved from wearing a bra supports the notion that your problem is not bottoming out.

Bottom line: you are not bottoming out, but you still have a problem with heavy ptotic breasts that are causing you discomfort. Follow up with your surgeon to discuss your options. They may include placing the implants under the muscle, or going to a smaller size. Good luck.

Best regards,

Lawrence Tong MD FACS FRCSC

Lawrence Tong, MD
Toronto Plastic Surgeon

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.