Implant Downsize? Implants Bottomed out 41YO?

Is it worth it to get smaller implants with internal stitches to make pocket smaller? I have 600 silicone right now. Don't they use internal stitches on regular surgeries? They bottomed out and not sure if it would cause more issues to downsize.

Doctor Answers 8

Large implant bottomed out after breast augmentation

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When you have a bottomed out from a breast implant then your breast skin/tissue is not strong enough to hold the weight of your implant. There are several options to correct this depending on the quality of your skin, the integrity of your bottom breast fold, the amount of skin and breast tissue that you currently have and your personal goal about the size/shape of your breast. Without photo and in person evaluation it's difficult to determine what's the best way to improve your situation. Downsizing and making the pocket smaller are two of the most commonly used techniques to improve but not necessarily the only options available. 

Best Wishes,

Stewart Wang, MD FACS, Wang Plastic Surgery

Los Angeles Plastic Surgeon
4.6 out of 5 stars 28 reviews


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Without an exam or pictures it will be so hard to determine what results you would get. You will most likely need some kind of lift.

Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

Downsizing not necessarily necessary...

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Without photographs its difficult to give you an exact answer but making the implants smaller may not be necessary.  If the implants are above the muscle simply putting them below the muscle may solve the problem.  If not, usually when implants "bottom out" its not because the implant is too big but because the pocket has been created too low!!!

The best way to repair the situation is to place one or two layers of internal sutures to reconstruct the breast fold where it belongs.  This can be done through areolar incisions or incisions in the breast fold depending on what was used originally.  The internal stitches you describe are commonly used to close whatever incision has been used to place the implants into the breasts...the sutures I'm describing are different because they recreate and define the breast fold.

Eric Sadeh, MD
Manhattan Plastic Surgeon

Breast bottom out

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This is a difficult problem and is often caused by large breast implants.  The solution is not smaller implants only. You must shorten the distance between the nipple and breast fold with strong internal sutures. Ther ios no short cut here. best of luck

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 81 reviews

Downsize and internal sutures

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I fyou have bottoming out, often it is recommended to decrease the volume of implants( less weight) and resuspend the breast fold.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Bottoming Out of Breast Implants and Repair with Internal Sutures?

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As you can imagine, it is not possible to give you precise advice about your situation without direct examination or, at least, viewing pictures. Generally speaking, internal sutures ( capsulorrhaphy) is a procedure that can be used for patients who require some type of adjustment made to their breast and plant pockets. For example, internal sutures may be used to help reconstruct the inframammary fold areas,  when breast implants have “bottomed out”.  This technique may also be helpful for patients who are looking to downsize their breast implants significantly.

 This technique is not used on patients undergoing first-time breast augmentation surgery; I'm assuming that is what you are referring to in your question when you ask about “regular surgeries”.

 For more precise advice, seek consultation with board-certified plastic surgeons who can demonstrate significant experience helping patients with your situation.

Best wishes.

Breast Implant Bottoming Out

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Great question, and thanks for submitting.  This is a difficult question to provide a detailed answer without photographs to see.  Yes, the implant pocket can be, and is commonly, made smaller with internal sutures.  Depending on how much smaller you want to go, and how much bottoming out and breast sagging you have, it is possible you may need a breast lift at the same time.  Best wishes!

Brian Howard, MD (retired)
Alpharetta Plastic Surgeon

Implant size, Internal stitches Bottomed out implants

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Bottoming out is not an uncommon problem when larger implants are inserted.

The pocket required to properly place the implant it may cross the ligaments which support the implant from below.

When a soft capsule forms the implant can then slide down the chest wall causing a "bottoming out".

Often this is not determined at the time of primary surgery and is only realized after this occurs.

Using a smaller implant and internal sutures to recreate this inframammary support is the most conservative approach. 

Opening the capsule higher up is another option which may result in too high riding an implant.

Luis A. Cenedese, MD, FACS
New York Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.