Which BA technique to avoid bottoming out? (Photo)

I am troubled by the term 'bottoming out' because it attaches some stigma to something which is most principally caused by the characteristics of your own tissues and not by the choice and execution of surgical technique/implant etc and also its something that is not necessarily unattractive when you consider that there is no such thing as a 'normal' breast.

its all to do with the stretch that comes with having an implant or from changing the shape of breast with breast uplift or breast reduction technique - if the lower pole of the breast stretches out more than the upper part then this makes the lower part of the breast seem fuller.

There is some subjectivity with measuring pocket or base dimensions so i am not surprised if there is a difference in the way this has been measured.

under-muscle and 'dual plane' are very similar techniques - dual plane just sounds a bit more flash. either way the muscle only covers the upper 50% or so of the implant so it doesn't defend against stretch in the lower part of the breast - the reason to go under muscle is to reduce the chance of feeling implants through the surface in the upper zone of the breast and also it will hvae a slight flattening effect on round implants - so if you have very thin skin here - test by pinching up the skin midway between nipple and collar bone - if less than half an inch of pinch then I would recommend placing implant under the pec muscle.

things which might help to minimise lower pole stretch in my view are:
1. err on side of choosing a smaller implant
2. consider an anatomic implant as you have better control of shape
3. ensure that there is as little disturbance as possible to under-breast fold (IMF) the IMF is there because of a zone of tiny ligaments which hold the skin closer to ribs - so access scar and internal dissection should stay nicely on the upper side of this zone in order to give maximum possible support and hopefully minimise lower pole stretch/descent

The best way to avoid bottoming out is to choose an implant that fits within the normal boundries of your breasts and preserves your natural inframammary fold. The inframammary folds strength prevents inferior migration of an implant, so choosing an implant which would require lowering the fold and creation of a new fold using sutures, to accommodate a larger implant is possible, but the re-created fold is never as strong as the native fold. Other options for creating a fold below your native fold would be the use of a reinforcing material such as Galaflex, which is a mesh sutured in at the level of the new fold and incorporates into your bodies tissues, but creates a stronger lower fold than could be obtained with sutures alone, although at an increase cost. Dual plane pockets, simply referred to the different amounts the pectoral muscle is divided and separated from the breast tissue to achieve optimal shape in a breast augmentation. Best wishes.