What causes bottoming-out and can that occur without implants? I'm considering a lift without implants.

Over time, the relentless pull of gravity will alter every result irrespective of the specific details. Larger breasts (according to Newton) descend over time as the retaining ligaments weaken and the skin envelope thins out. A larger, heavier implant will drop faster than a relatively smaller device. Similarly a larger, heavier, breast will do the same.Bottoming out refers specifically to the process by which the implant descends behind the breast mound stretching the IMF to nipple distance. This is best addressed by capsulorrhaphy (or reinforcing the capsule at the fold) +/- the addition of a support matrix such as Strattice/ADM. It is also often prudent to downsize concurrently in order to decrease the risk of/rate of recurrence.With regards to your specific question, risk factors for bottoming out include, large implants, disruption of the native fold, and poor native tissue support.As always, discuss your  concerns with a board certified plastic surgeon (ABPS).

Bottoming out can be related to breast implants that are too heavy. So over time, the patient's tissues cannot hold the implant in the proper position. This can lead to the implants and the breasts sitting too low on the chest.With a mastopexy or breast lift, bottoming out can occur if the patient's tissues cannot hold the weight of the natural breast tissue over time. The uplifted volume will gradually shift to the inferior aspect of the breast and make it look bottom heavy. Of course, this does not always occur. It usually depends on the quality of the patient's tissues. Best of luck!

Hello,
There will always be some increasing laxity in the lower breast. That is caused by healing and gravity. As a surgeon we will try and guess how much laxity is likely to occur and to plan the surgery accordingly and to compensate for that effect. Not everything is predictable and manageable. Patients with poor tissue quality don't have enough elasticity to counteract that.
In general, a higher risk of unfavourable results with bottoming out can be found in smokers, after significant weight loss, pregnancies and breast feeding or in patients that have stretchmarks or droopy breasts at a very young age.

Bottoming out is when the implant settles to the bottom of the tissue and a majority of the implant is below the nipple area. If you look at a breast, about 70-80% of the fullness is below the nipple and only 10-20% of the breast is above. To correct this, best options are to go with a slightly smaller implant, and also to consider a breast lift where you tighten the bottom of the breast and allow the implant to sit in a nicer position where you have a good portion of the implant that sits above the nipple. So you have maybe 40% above and about 60% below. I think that is a more pleasing contour, than when 80% of the implant is sitting below the nipple.

It is typically caused by weakness of the tissues, or implant weight.  There are techniques that can be used to lessen the risk of this over time.

As ageing occurs, the supporting ligaments of the breast and the skin weaken.  The heavier the breast, the more likely this is to occur. When the weight of an implant is added, there is more stress on the supporting structures.Breast lifts and reductions which avoid a horizontal incision along the breast crease, hold up better over the long run.  Incisions are around the areola and straight down to the inframammary crease.  Through these incisions the breast tissue can be reshaped and/or resected as needed.  The inframammary crease is not disrupted and bottoming out is rare.

Hi there. Thank you for your question.  Bottoming out refers to sagging of the breasts below the nipple and can occur with normal breast as well as with breast implants.  It is less common folwoing an uplift but amy occur with large breasts, thin skin and disruption of teh natural crease under the breast.  I recommend the light weight B-Lite implants especially for larger volume to avoid the risk of bottoming out.  Hope this helps and good luck

"Bottoming Out" is a common problem in the breast augmentation arena and is related to several factors that are anatomic and physical.  The data is clear and mirrors my personal experience; the larger the implant, the greater the risk.  It is, however, not that simple.  
Submuscular placement is an advantage over sub-glandular position, but even when an implant is placed in a sub-pectoral pocket, there is no muscle coverage infero-laterally.  Bottoming out can still occur!  When implants are too large for a given patient, this accelerates the problem and less of the implant is covered by muscle, and therefore, there is less support.  
Lower pole support is the pivotal issue here.  This is variable from patient to patient and is something that should be discussed during a consultation.  Patient behavior and activity is a major contributor after surgery.  Patients who are avid runners or ride horses tend to have more repeatd vertical displacement of the implant over time.  I typically recommend consideration toward a textured implant in these patients as they tend to move less and do not stretch out the pocket. 
Bottoming out is rarely an issue with pure breast lift surgery, but is a common problem with breast reduction, particularly with inferior pedicle designs.  This should be discussed with your surgeon! Remember, that surgeons can only control anatomy in the OR and not down the road in the future.  You should never assume that this is your last breast lift procedure, or that you may not require revision surgery in the future.  Good Luck!