Do I Have Bottoming Out? (photo)

I'm 5'11, 120 lbs, ribs 32, in August I had a breast aug. Pre-op I was an A. I got under the muscle, mentor silicone 270 cc round Ultra High Profile Gel Cohesive 1. These are my breasts 4 mo. post op. Im concerned that my nipples are too high & the breast mounds are centered? In the past month and half i was noticing this problem when they were shrinking. Could it have been my sports bra? I feel like it moved them center and wasnt supportive enough. Is there time to reverse this? What do I do?

Doctor Answers 12

Do I Have Bottoming Out? (photo)

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I agree with the other posts. The only way you can correct this is to have another surgery to elevate the implants to a higher position- it appears that they were placed too low during surgery.  Not likely that your sports bra had anything to do with it.  Good luck!

Newport Beach Plastic Surgeon
4.9 out of 5 stars 109 reviews

Breast Implant Malposition

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As others have stated, your implants are too low and too close together (symmastia).  Technically, I wouldn't call this bottoming out.  Rather your implant pocket slooks like they were too low to begin with. In order to fix this problem, you will need additional surgery.  The implant pockets need to be adjusted so that they are higher and further apart.  This is called a capsulopexy or capsulorrhaphy.  

I would agree that you should find a board certified plastic surgeon in your area who is experienced in revisionary breast implant surgery.  Good Luck

Laurence Weider, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 102 reviews

Deformity of breasts after breast augmentation

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Thanks for your excellent photos which unfortunately indicate a significant issue which you have noticed. The origin of the deformity and undesirable appearance of your breasts is not a result of bottoming out or related to any issues with your sports bra. Instead, it is the consequence of the breast implants having been placed far too low and too close together. These issues will need to be corrected surgically and by a (another) board certified plastic surgeon who is experienced with this. Fortunately, it should be correctable.

Good luck!

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

You need revision surgery

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You have bottoming out of the implant. The main problem is the disruption of the infra-mammary fold attachments and there is no support for the implants. Your surgeon tried to give you cleavage and this disrupted the support for the implants.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

Symmastia and breast implants

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Your are 5'11" and the implant you describe has only a 9.5cm diameter so it should not be too big for your rib cage. The photos show the implants positioned too low on and too close to the midline of the rib cage (symmastia). They will need to be repositioned higher and further out. That means the pockets will need adjusting and if the capsules are too thin to hold a suture the only way to do that will be by using dermal matrix.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Breast Implant malposition

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Hello Skinnieminnie,

To confirm, you have implant malposition, and it is never caused by a garment or strap.  Gaining weight and exercise will not improve the appearance.  Going forward, the implant pocket needs to be modified in a way that your implants will be farther apart and sitting higher on the chest wall. Capsulorrhaphy is one way to effect this change in implant position.  It is technically demanding, and requires sutures under tension to keep the pocket closed.  For people like you who have an element of 'symmastia', I prefer another technique where a new submuscular pocket is created by closing off the old scar capsule to itself, allowing the implant to sit on top of the 'obliterated' scar capsule while still being under the pectoralis muscle. 

In addition, ultra high profile implants have no good use in most individuals, especially someone that is thin, with (apparently) tight breast tissue.  I completely understand your surgeons choice though: to give you as much volume as possible in the smallest place.  Unfortunately, fitting implants to breast base diameter is only one of many parameters needed to assess proper implant size and projection.  You will need a smaller and flatter implant.

Revision breast surgery is more difficult and should be performed by surgeons that specialize in it and have an excellent reputation for doing so.  Certification with the American Board of Plastic Surgery and membership with the American Society for Aesthetic Surgery is just a baseline, but necessary requirement.

Best of luck.

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Implant Malposition

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You definitely will need additional surgery to correct the implant malposition.  You need to seek a board-certified plastic surgeon that has experience in correcting this problem.  Even in the best hands, it may require more than one surgery to correct this problem. 

Breast Implant Malposition

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The responses have been very consistent, which should help you decide what to do. What ever the cause, yu have breast implant malposition, which means they are not positioned in the fight place on your chest wall. The implant capsules will need to be corrected by closing off part of the lower and inner portions and expanding the upper and outer segments (capsulorrhaphy). This is a technically demanding procedure so be sure you have a board certified plastic surgeon with sufficient experience with this procedure. You also may be better served with  a moderate plus profile.


Joseph Fata, MD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 105 reviews

Implant is positioned too low and too close to the midline (center) of your chest.

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Bottoming out is a term that is used to describe the process of the implant drifting lower on the chest.  It appears that your pocket was created to low to begin with.  So in a sense, you do not have bottoming out but your implants are improperly positioned (too low and too far inward).  This ca be corrected through a capsullorhaphy or internal suturing of the breast pocket.  Unfortunately, in doing so, your breast fold incision will end up being lower than idea since the new breast fold will be higher.  The old incision can be revised down the road when all healing has occurred.

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Augmentation Revision

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Yes, I think you will need to have a breast implant pocket revision. Ideally, your implants should be centered under the nipples. In other words, the nipples should be in the center of the breast mound. It appears your implants are positioned too low and too close together.

William H. Gorman, MD
Austin Plastic Surgeon
4.0 out of 5 stars 19 reviews

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.