Do high profile implants bottom out more?

The tendency to bottom out is more dependent on size of the implant, rather than profile. Larger implants have a greater risk of bottoming out, especially if they exceed the body frame of the patient or if the patient has lax skin or poor tissue quality.

Implants bottom out from a number of reasons. Sometimes the implants are too heavy or large for the tissue to support them. Sometimes it is that the tissue is too thin or not strong enough to support the implant. When bottoming out occurs patients can consider switching to smaller implants. Another recommendation may be using bioabsorbable mesh to support the lower pole of the breast.

The potential to bottom out or cause inframammary fold malposition is dictated not by the implant, but by the surgical technique used to do the operation. There are several things that are required when doing a breast augmentation, revision, or mastopexy with augmentation that will maintain the inframammary fold and minimize the risks of bottoming out. It is crucial to close the incision appropriately, ensuring that scarp(s) fascia is re-secured to the chest wall before closing the skin. Many surgeons do not understand this concept and just close the skin and this increases the risks for bottoming out. Additionally, for patients with loose or weak tissues, sometimes use of a supportive mesh or scaffolding (Galaflex) may be warranted to further support the fold which reduces the chance of bottoming out. Certainly, the more weight that is placed on the fold will increase the likelihood of fold malposition, but generally speaking, bottoming out is a technical problem caused either by over dissection, poor closure, weak tissues, or all of the above.