Is this the start of bottoming out 3 months post op? Under muscle placement, 440cc Motiva progressive gel plus (Photo)

Yes, you are bottoming out. No, this is not because you have too-large implants, it is because your surgeon made the pockets too low, or did not factor in the effects of healing, softening, and stretch under the ever-present physical fact of gravity.I see this problem all-too-frequently when my colleagues place a woman's implants in the "perfect" position in the operating room, even confirmed by upright positioning on the operating table, and then hope to negate the effects of gravity with an Ace bandage, elastic bandeau, or supportive surgical bra. Look in any nursing home to see how trying to outwit gravity works out!Sometimes surgeons who DO take into the accounts of gravity by placing the implants a bit higher than their final desired position will STILL have bottoming out occur. At least we tried, and next time we get a bit better at trying to determine just how much to try to counteract gravity, healing, and stretch/settling over time. After a few years and thousands of implants some of us actually get pretty good at this. But bottoming out still occurs occasionally despite everyone's best efforts. When it does, blaming the implant is not the proper "solution," IMHO. Just repair the capsule, over-correct it a bit to allow for gravity and healing a second time, and have your patient wear a supportive bra to help the healing day and night for at least 3 months (longer is better). Successful repair is not guaranteed, but switching to smaller implants simply shifts the "blame." Not necessary, and frankly (since you would have to go down a substantial amount to make a difference), simply trading one problem (bottoming out) for another (too small implants, too-wide cleavage, and less upper pole fullness) makes no sense to me. Just my two cents' worth! Best wishes! Dr. Tholen

Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.Bottoming out and Side Boobs Contributing Factors:Larger/Heavier ImplantsImplants placed above the pectoralis muscleChronically not wearing a bra when uprightOver dissection of the Implant PocketSmooth ImplantsLarge swings of weight including pregnancySkin and soft tissue laxity, loss of elasticity

Yes, your implants are bottoming out. This is why your nipples appear too high. The only solution at three months out to perform a revision surgery where the lower portion, where the fold used to be, gets stitched back down to reinforce and lift the implants. Then, an under wire or support bra while it is healing. Discuss this further with your surgeon, or with a second opinion.Best of luck!Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

from your photos it appears that your right implant is lower and causing your nipple to sit higher. You would need to have the lower pole to be repaired to raise the inframammary fold to match the other side.

You do appear to be bottoming out a bit.  In general, only a procedure to tighten your lower pole would be indicated.  However, a smaller implant would put less tension on the repair and would likely entail less of a risk of this occuring in the future.