Have my implants bottomed out? (Photos)

Your photos show the nipple-areola sitting relatively high on the breast mound with more lower-pole fullness, especially on the side views; photos cannot confirm the implant pocket, fold level, or tissue support. This pattern can happen when the implant has dropped too low or the inframammary fold/pocket has stretched, which is often described as bottoming out.
If this is early after surgery, some shape change can be normal, but progressive upward nipple orientation, increasing lower-pole fullness, or a fold/scar that seems to be shifting should be evaluated by your surgeon. Treatment depends on exam and timing; if true bottoming out is present, correction may require pocket repair, capsulorrhaphy, internal support, fold adjustment, and sometimes implant size or profile change rather than simply waiting.

Persistent886287
Thanks for your question. Based on your picture, the left implant has "bottomed out" below the original breast fold. This is because the left breast incision is no longer at your fold, but rather above it. The implant has started a downward descent, which causes upturning of the nipple. The right appears to be in place. Hope that helps.

Bottoming out refers to the descent of the implant below the level of the fold. A rising scar is often times a tell tale sign of a falling implant. A stargazing nipple is a similar sign as the breast mound autorotates upward as an implant slowly moves south.

Based on your photos, your left breast appears to demonstrate signs of bottoming out:
-Rising scar
-Stargazing NAC
-Lower sitting implant

It is also important to note, the risk of bottoming out is higher when an IMF incision is used.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon at Lone Star Plastic Surgery – Frisco, TX:
Thank you for sharing your question and photos, they help tremendously in assessing what might be happening. Based on the appearance you described and what I can see, it does appear that bottoming out is a possibility.
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It is often difficult to make an assessment from photographs. It seems you may have significant asymmetry of the nipples, but again it is hard to tell without seeing your shoulder position well and other findings. You should feel confident about going back to your surgeon for a good examination and a discussion on how you might proceed with a possible revision. Good luck.

Dear Persistent886287,

bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.

Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.

If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.



Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Based on the position of your scars, I don't think there is a significant amount of bottoming out. Looking at the left lateral view, the implant looks like it may be slightly below the inframammary fold, which could indicate early bottoming out. Have you noticed a significant change in the position of the implants over the last few months? If you have noticed a difference in the past few months, it might be possible to address this with doing some work on the capsule around the implant.
Another factor I would consider is the profile of the implant that you have. Again looking at the side-view photos, it looks like the nipple-areolar complex is a little above the most projected point of the implant, which can give the nipple an upward projection. If that is the case, using an implant that has a different profile (i.e. wider diameter), could elevate where the most point of maximal projection sits on the chest.

From the photos it does appear that your implants are bottoming out. This can happen for a variety of reasons, but a revision is needed to correct it. Sometimes exchanging for smaller implants is recommended. Another option is adding bioabsorbable mesh to give more support to the tissues. I've included a video I hope you find helpful.

The treatment is a surgery to correct the fold of the breast. Often a synthetic mesh or allograft is used to aid in the repair. A consultation with your surgeon will help.

Based on your nicely, post photo as your result is acceptable, but if you’re unhappy, the only option is to do research surgery with the use of an internal matrix to tighten the inferior pocket. Best of virtual consult with for better explanation. Expect fee to arrange from $8000-$12,000