Is my right implant bottoming out? (Photos)

Question

I had 800cc implants put in , i had 425cc implants in 20 years ago and i had a lump in my right boob and the implant was high almost to my shoulder , so i had them changed for 80pcc but now my right one is lower down and bigger , i actually prefer it because the left one doesnt look any biggrr but i think the right might be bottoming out

Emre Guvercin, MD, FEBOPRAS · Answer

Based on your description, your right implant may be sitting lower than the left, but this does not necessarily mean it is bottoming out. True bottoming out occurs when the implant descends below the intended inframammary fold, often increasing the distance between the nipple and the breast crease and making the nipple appear relatively high on the breast mound.
Since your previous right implant was positioned unusually high, the current difference may also reflect asymmetric pocket positioning or incomplete settling of the left implant. The fact that you prefer the appearance of the right breast is important.
I would assess the nipple-to-fold distances, inframammary fold positions, and implant pockets before recommending any correction. If the right implant is appropriately positioned and the left remains too high, releasing or adjusting the left pocket may be more appropriate than lifting the right implant.
With 800 cc implants, maintaining stable lower-pole support is particularly important. An in-person examination is necessary to distinguish true bottoming out from implant-position asymmetry.

Daniel Barrett, MD · Answer

Dear nat19802013,

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

Mert Demirel, MD · Answer

A right breast that sits lower and looks bigger after going from 425cc to a much larger implant can be bottoming out, but it can also be normal settling or a difference in the pocket between the two sides. The key is not how the breast looks from the front, but where the implant sits relative to the fold underneath and where your nipple points.
With bottoming out, the implant drops below the original fold. The distance from the nipple to the fold gets noticeably longer on that side, the lower scar or fold may move down onto the abdomen or chest wall, and the nipple starts to point upward because the implant is sitting under it rather than behind it. With very large implants, stretching of the lower pole is more common because of the weight, especially when the tissue was already thinned by a previous implant.
Since you mention a lump in the right breast before the exchange, it's also important that this side has been fully evaluated. If the lump was assessed at the time of surgery, ask what it turned out to be. If anything is new, such as swelling, a change in size over weeks rather than months, firmness or pain, see your surgeon promptly. An ultrasound can show whether there is fluid around the implant.
If you like how the right side looks and it is stable, there is no need to rush into surgery. The concern with true bottoming out is that it tends to progress over time, so monitoring matters. If it does continue to drop, the usual repair is to tighten the lower pocket with internal sutures, sometimes with a support material. In some cases this is combined with a smaller or lighter implant.
My advice would be to ask your surgeon to measure the nipple-to-fold distance on both sides and compare it with your measurements right after surgery. Ask whether the fold has moved, whether the implant is still centered behind the nipple, and what the lump in your right breast was. Then decide together whether to monitor or correct, rather than basing it on appearance alone.

Is my right implant bottoming out? (Photos)

Answers (3)

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