How can I fix bottoming out due to skin stretching without it happening again? What is the best option for my goals?

Since your incision is in the fold, you do not have true bottomed by out.  As you said, your lower pole tissue has simply stretched out more, allowing the implant to settle more into that position.  You need to decrease the distance from your nipple to the breast fold.  The best way to do this is to remove excess skin from the lower pole along the breast crease.  This gives you a longer scar, but allows you to control the skin.  The skin that is not needed can actually be used in such a way to help strengthen the skin that is left.  That in combination  with securing the sides internally should stabilize the implant in its proper position.  You are welcome to come for a consultation and see what will work best for you.  I hope this helps.

thank you for your question in your photos. You clearly have some bottoming out as well as lateral displacement of your breast implants. You will benefit from combination of techniques including internal Bra/mesh/ADM support, implant pocket revision and slightly smaller breast implant.It's best to have a thorough in person consultation with a board-certified plastic surgeon in your area to discuss all of your treatment options. Best of luck!
Dr. Dhaval M.PatelDouble Board Certified Plastic SurgeonChicago-Water Tower Place, Oakbrook, Hoffman Estates, Orland Park

I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are  appropriate; your breast implants• do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out” and lateral displacement).

Common signs of breast implant bottoming out include: 
1. Breast implant "sits" too low on the chest wall.
2.  Excessive palpability or visibility of the breast implant along the lower breast pole.
3.  Nipple/areola complex seems to be sitting relatively high, because the breast implants have settled too low. 
4. Discomfort along the lower breast pole (secondary to pressure from the underlying implant).
5. Relative paucity of upper pole breast implant volume compared to lower pole volume.
6. Increased visibility of a infra mammary fold scar (higher on the breast mound).

I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair).  This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly.  Associated issues with positioning of nipple/areola complexes and visibility of the inframmammary fold scars should improve with this operation. Breast lifting will not be necessary.
Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with this type of revisionary breast surgery.
 
I hope this, and the attached link, helps.