Are my breast implants bottoming out? Will they need a revision? (Photos)

Question

Am I bottoming out ?

Ira H. Rex III, MD · Answer

It is difficult to say from the photographs whether there is any bottoming out.  It seems that this is probably not happening.  It would be helpful to know more specifically your concerns and why you are asking this.  If you more pictures would help also.  Its often with going back to your surgeon to review any special concern you have and get a good exam.  Good luck.

Daniel Barrett, MD · Answer

Dear magicjam,

bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.

Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.

If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Leila Kasrai, MD, FRCSC · Answer

Your breast implants seem to be centred behind your nipples, therefore they don’t appear to be bottoming out.

Wayne I. Yamahata, MD · Answer

Your photos show some asymmetry but no apparent signs of bottoming out. Without preop photos or a physical examination, it's not possible to render an opinion on a revision for asymmetry.

Zoran Potparic, MD · Answer

It does not look that your implants are bottoming out, based on these photos. There is small asymmetry in size and position of areolas, but this was very likely preexisting condition. You seem to be ok.

George Marosan, MD · Answer

Thank you for your question and photos. Based on these photos, you do have a nice result in placement and shape. There's some asymmetry, which is normal (no preop photos posted). Your incisions sit right on the inframammary fold and the implants did not migrate below the fold. I personally, would suggest against revision surgery at this point.

Frank Agullo, MD · Answer

It's hard to tell without seeing a change from a photo 6-12 months before. You can see that the surgeon put your scars right in the inframammary fold, and they are still pretty close to it. Aside from slight asymmetries, it doesn;t look like you are bottoming out.

#StayBeautiful,

@RealDrWorldWide

#StayBeautiful,

@RealDrWorldWide

George Volpe, MD · Answer

My 1st impression is that they are not bottoming out. It does appear that the fold under the breasts are still there although without a physical exam it is hard to tell for sure. Bottoming out usually happens when the implants lose support of the small ligaments under the skin that create the fold under the breast which then allows the implant to descend below the fold of the breast. This usually takes some time to occur. There is no mention as to how long after surgery the photos were taken but if it has been a number of months, it looks as if the breasts are healing appropriately. If you have concerns, it should be discussed with your surgeon. It is hard to tell by the scar whether someone is bottoming out as some surgeons place the scar exactly on the crease and others slightly above the crease. I favor above the crease by a half inch or so. That allows one to raise one's arms while wearing a bathing suit top without the scar peeking out at the most bottom part of the breast.

Donovan Rosas, MD · Answer

Bottoming out refers to the descent of the implant below the level of the fold. A rising scar is often times a tell tale sign of a falling implant. A stargazing nipple is a similar sign as the breast mound autorotates upward as an implant slowly moves south.
It is difficult to say based upon photos alone. Pre-op photos for comparison and a timeline can help offer more insight. 
In order to correct, surgical revision is necessary. It will include resetting the fold and potential addition of supportive mesh. 
As always, discuss your concerns with a board certified plastic surgeon (ABPS)

Yasemin Aydinli, MD · Answer

Thank you for your photos. First, the reassuring part: looking at your images, your implants do not appear to be bottoming out to me. In bottoming out, the implant drops below the original breast fold so the nipple starts to point upward and almost all the fullness collects in the lower pole &mdash; and that's not the pattern I'm seeing here. Your nipple position and lower-pole fullness look within a normal range from the photos.
That said, a photo can only tell us so much. A definitive answer really depends on measurements taken in person &mdash; specifically the distance from the nipple to the inframammary fold and whether that fold has dropped compared to your original one. If those measurements are stable, then there's nothing to revise. If you ever notice the nipples beginning to point upward, the fold dropping, or increasing fullness at the very bottom of the breast over time, that would be the moment to be re-examined.
For now, based on what I can see, I wouldn't be concerned and I wouldn't recommend a revision on the basis of these photos. If you'd like certainty, a quick in-person exam with measurements will confirm it, and a well-fitting supportive bra is always a good idea to help maintain your result.

Are my breast implants bottoming out? Will they need a revision? (Photos)

Answers (12)

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