Is there anything I can do to prevent bottoming out?

There are several things that contribute to bottoming out, one being implant size. The bigger (and therefore heavier) the implant, the more it will stress the tissues that hold it up. Saline implants may be more likely to bottom out because of fluid wave pressures. Textured implants might stick in place better but they are usually firmer. Wearing an underwire bra compulsively is also a good idea. 

There are multiple factors that contribute to bottoming out.  There are probably only two that your choice could influence: size and texturing.  The bigger they are the harder they fall is an old adage but true.  Unfortunately surgeon's have no capability to measure or predict how much weight your tissues can maintain.  Texturing of certain manufacturers may help minimize this complication but as you attested to there are trade offs in the "feel" of the augmented breast.  Why not have another experienced board certified plastic surgeon examine you and listen to both opinions.  Mom always said that no one ever died from too much advise.  Best Wishes

Drop out is when the implant descends well below the center of the nipple.  Patients with a weak breast fold, larger implants, and smooth implants are more at risk.  I recommend textured implants, reasonable size, and post operative bra support at all times for 6 months.  The most important, however, with a fold incision approach is to do a really good deep tissue repair with a long lasting suture like PDS.  I think this forms a kind of shelf for the implant to sit on until a capsule is formed.

Bottoming our occurs when there is not enought support to keep the implant in proper postion. This can be made more likely with a larger and therefore heavier implant. Texturing has been shown to decrease the bottoming out rate. So a smaller textured implant and wearing a good support bra post operatively will decrease your chances of bottoming out. Good luck.

Bottoming out can happen for several reasons. Your surgeon will recommend post-op care to you regarding what activities your should/shouldn't do.  You can not prevent bottoming out per se.

there are several factors involved in this process. your surgeon needs to do a good deep closure. however if the implant is large and heavy, then it will stress your tissues and may cause bottoming out. also, you need good bra support. you  need to have decreased activity for 4 weeks after surgery to allow the pocket to heal in the original surgical position. textured implants would help, but they are slightly thicker to the feel.