Risk of bottoming out. (photos)

I was wondering when bottoming out is happening? I have 255cc in each breast, anatomic implants. My PS lowered my fold since it was only 1 inch to begin with. I am afraid of bottoming out, and was wondering when the risk of this happening is "over"? Is it normal for one to sit higher then the other? Would also be very happy to know your opinion about the before and after photos. Not sure how its supposed to look and can't see my PS because he's on vacation for another week.

Doctor Answers 10

Risk of breast implants bottoming out.

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Thank you for your question.  I do not see evidence of bottoming out in the current photographed.  Ear incision looks appropriately placed.  Of course you should see her plastic surgeon for an exam and not rely on Internet advice.

Breast implants Bottoming out

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bottoming out usually does not happen immediately or overnight. It usually takes a while. With patients who are small framed with tight chests, I have changed from using permanent sutures to long acting dissolvable sutures to tack down the fold. I have found that once your capsule is well formed, generally holding up the fold with sutures is not necessary. 

Your photos at this point look fine and I see no evidence of bottoming out. 

Lily Lee, MD
Pasadena Plastic Surgeon
5.0 out of 5 stars 29 reviews

Risk for bottoming out

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with textured anatomic implants like yours are negligible if everything heals as desired.  When it does, your implant should not move at all.  You will have softening of your mounds and a mild diminishment in size due to your swelling resolving.  Everything looks fine at this point and focus on healing and following your surgeon's recommendations.  But if you truly have a concern, you should be able to contact your surgeon (or whomever is covering) anytime you have a question

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Am I "bottoming out"?

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Hello, you are not "bottoming out". This is not a possible occurrence right after surgery. If your question is do your breasts look normal, that is different. From your before photos, it is apparent that although your breasts are very small they are also quite asymmetric. Those asymmetries become more obvious after having breast augmentation so you can expect to always have asymmetry. However, there is not much to judge so early after surgery. In fact, I urge you to keep your breasts covered and stop looking at them so much in this early period. You have a few to several months to go before recovery is complete and your implants have stabilized in your tissues.

Orna Fisher, MD
Palo Alto Plastic Surgeon
4.4 out of 5 stars 14 reviews

Bottoming out

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The term "Bottoming out", I find is many times used inappropriately. It refers to a clinical situation in which the majority of the implant is below the most projecting mound or aspect of the breast. Ideally, the distance from the top of the breast to the nipple should be 45% of the distance from the top of the breast to the fold. It takes  6 months for the implant to settle into its new position. Therefore, it is really only at this time that one can determine based on the position of the implant in relation to the fold and the most projecting aspect of the breast, whether the implant has truly bottomed out. The bottom line is that one needs to wait 6 months before determining whether the implant has reached its final position. It is possible to begin bottoming out prior to this, but one needs to wait 6 months to assess the final position of the implant. Give it time and determine how you look at 6 months postop. Looking at before and after pics at this time will also shed light on the situation.

Best wishes,

Dr. Ravi Somayazula

Ravi Somayazula, DO
Houston Plastic Surgeon
4.8 out of 5 stars 71 reviews

1 Week Post Op

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Thank you for the question and photos. Your incisions/crease placement seem to be intact and holding well. The left implant is sitting higher at the moment but that can be a normal asymmetry early post op. Swelling and tight tissue is compressing your implants and the appearance can be quite unexpected or concerning for patients. I recommend that you continue to follow post op instructions carefully and you will be able to get some reassurance from your Surgeon when they see you.

All the best

Breast Implant Bottoming

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It generally will take some time before bottoming out happens.  In general that is more common with smooth round implants than with anatomic implants.  Though you are early in the postoperative period, I would concentrate on your recovery, as you have a great result.  Continue to follow your surgeons recommendations as far as do's and don'ts.  It will be about 4-6 months before you have appreciate your final result.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

When Do Implants "Bottom Out"?

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Judging from your photos, you appear to have a very tight chest wall. Bottoming out could potentially take a bit longer in your case; however, everyone is different in terms of how long "bottoming out" takes. Of course it is normal to be nervous and want the complete results immediately, but I urge you to be patient. Set up a follow-up appointment with your plastic surgeon so that you can discuss your concerns with him or her, because your surgeon will be able to speak to you specifically, having performed the surgery. There is another approach to putting in implants called the Transaxillary Subpectoral Approach in which the incision is made in the underarm so that no incisions are near the breast. Because your incisions are under the breast, please be careful not to expose them to the California sun as you heal.

Looks fine

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From the appearance of your starting photographs, it's my opinion that your surgeon did an A+ job of placing tall implants in a shorter nipple to fold distance. In my experience, it takes many months before anyone would see bottoming out. Early signs would be the incision, which now is exactly in the crease starts to ride up on the breast. I would recommend you follow-up with your surgeon's postop protocol. Congratulations on your surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 58 reviews

Risk of bottoming out.

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Your concerns are understandable but it is much too early to evaluate the long-term outcome of the procedure performed;  some degree of asymmetry is certainly common at this point.  I would not have specific concerns about bottoming out at this point.

 Although easier said than done, I would encourage you to continue to exercise patience.    Keep in mind that it will take several months for you to see the final outcome of the procedure performed. Best wishes for an outcome that you will be pleased with long-term.

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.