I am 5'5", 114 lbs, and 2 1/2 months post op with 300cc high profile silicone implants. Are my Implants Bottoming Out?

I am 5'5", 114 lbs, and 2 1/2 months post op with 300cc high profile silicone implants. My nipples seem high and I am concerned that they are bottoming out. The incision scar is also starting to creep up the bottom of both breasts. I am also concerned that the proper profile was not chosen for my desired results. I have included photos of myself from the front and either side, as well as a photo that I provided my PS of the type of result that I desired. What are your thoughts?

Doctor Answers 7

Bottoming out?

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Thank you for the question and pictures.

Yes I think your implants have settled a little too low. One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).

In your case, I would suggest repair of the  inferior breast capsule with permanent internal sutures (capsulorrhaphy). This involves removal of a segment of breast implant capsule among the inferior/lower aspect of the left breast implant pocket. The 2 edges of  capsule tissue are sutured to one another with permanent suture. This procedure reduces the size of the implant pocket and prevents the descent  of the implant on the left side.  Suturing to the ribs is not necessary and  complication prone. This procedure will improve the symmetry of the breasts  and the positioning of the nipple–areola on the left breast mound.
Make sure you're working with a well trained experienced board-certified plastic surgeon.  Capsulorrhaphy, even in the best of times, is not always successful and further revisionary surgery  including the use of allograft ( I use this material for cases of recurrent implant  malposition)  may be necessary.

I hope this helps.

Bottoming out of breast implants

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You may need to have the implants surgically adjusted so that the final position sits slightly higher than where they currently are located.  I would wait a few more months to allow the scar tissue to mature so that the scar tissue (capsule) can be used to reinforce your new, higher inframammary fold (breast crease).  Communicate your concerns with your plastic surgeon and he/she should be able to help you correct this condition.

Best wishes,

Dr. Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 412 reviews

Bottoming out implant

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Pre operative photos may have been helpful for your question.  It seems that your implants may be going a little low.  This can happen from a variety of reasons. The projection of your implants is usually less of an issue than the other variables at play, (i.e.; skin quality, chest wall abnormalities, soft tissue abnormalities, etc;).   Contact your plastic surgeon about your options. 

Jeffrey J. Roth, MD, FACS
Las Vegas Plastic Surgeon
4.6 out of 5 stars 17 reviews

Bottoming out

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It looks like your implants settled a bit too low. Pre-op photos would be helpful.  Some patients actually have nipples that appear high because they were high on the chest in the first place.  A good exam would be helpful. Speka with your surgeon.

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

Bottoming Out of Breast Implants

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What you are describing is a bottoming out of an implant. This likely occured because of an absence of support to the implant. This absence could be due to many reasons which include but are not limited to: poor skin quality; possilbe violation of the inframammary fold during the initial procedure, size of implants placed, and/or the technique used to place the implant.   But don't worry, this problem can definitively be corrected/improved with revisional surgery.   I have found that utilizing Alloderm or Strattice as an internal "bra" helps to definitively correct this problem. Please visit with an American Society of Plastic Surgeons member surgeon to learn more about your options.

Implant Concerns

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You may need to have a revision. I would suggest that you contact your Board certified Plastic Surgeon for an evaluation. Best wishes!

Christine Sullivan, MD
Columbus Plastic Surgeon
4.5 out of 5 stars 35 reviews

Implants bottoming out

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It looks like your implants have settled too far inferiorly. That can be corrected with a revision procedure called a capsulorrhaphy which elevates the inframammary fold with internal sutures, making the implants sit in a higher position. I do not think the problem is related to the type of implant (high profile) used.

James W. Ward, MD (retired)
Arlington 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.