What strategies do you as surgeons use to avoid bottoming out of implants?

Hello Jubilant2138,


I favor Dual-Plane
over Partial Submuscular (under the muscle) breast augmentation,
because Dual-Plane placement allows for a more natural appearance
while keeping the benefits of having the muscle cover the implant. On the other hand, under the muscle implant placement is typically more
painful, have a significant risk of bottoming out of the breast, and it’s associated with a longer period of recovery,
and more post-operative discomfort. Bottoming out
is a complication that occurs when the implant rides too low in the
breast tissue, causing the nipple to point upwards. Correction for bottoming out
involves breast augmentation revision surgery that recreates
the pockets within the breast that holds the implants. Patients with
poor skin elasticity are most at risk for this problem, which is often
accompanied by rippling. Placement of excessively large implants also
significantly increases the risk of bottoming
out.
I would recommend consulting with a board-certified and experienced plastic surgeon to assess your candidacy for breast augmentation and discuss your specific concerns. With appreciation, Dr. De La Cruz.

Thank you for sharing your question.  Using precise surgical technique and a well-sized implant relative to a patient's natural anatomy helps to limit the risk of bottoming out.  Hope this helps.

That’s a great question… In almost all women, the inframammary fold sits a little too high for most implants to provide a balanced breast (45% of the implant/volume above the nipple and 55% below)  and an almost all cases surgeons need to adjust that information refilled. My feeling and experience is anything that weakens that area too much could allow the implant to slip too low. Here is where I disagree with Dr. Burns. Having done the axillary approach for over 20 years now, I believe it has LESS of a tendency because there is no incision in the inframammary fold. The dermal fascial attachments are not weakened by the incision and the dissection, and I think it provides more support. therefore I think the axillary approach or periareolar has the lower chance of bottoming out but honestly, it all comes down to surgeon experience. Great results can be obtained with any incision!! I also think it helps if patients can get into a snug underwire bra once their implants settle where they like them. It may help to wear that for the first 6 to 8 weeks or so just to “lock them in place“. My favorite is the Victoria’s Secret Knockout bra