1 year post op Breast Augmentation, Is my Implant Bottoming Out?

I had breast augmentation done almost a year ago, and my left breast has always had the incision above my crease. It seems too low and outward. Is my implant bottoming out?

Doctor Answers 23

When Implants Cross The Line

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Under most circumstances, Breast Augmentation through an inframammary fold incision is planned in such a way that the location of the incision should coincide with the eventual or planned level of the fold. If the implant now lies below the fold, and the incision appears to ride up onto the undersurface of the breast/implant, your implants may indeed be "bottoming-out".

Larger, heavier breast implants especially, as well as those placed under the muscle, may have a greater tendency to bottom out, even if the original surgical pocket was created correctly. Another tip-off that the implant(s) are bottoming is if one fold appears lower than the other, or if the center of one or both implants seem to have fallen below the center of the breast, meaning that the upper breast above the nipple and areola appears flatter than desired, or less full than it appeared initially after Breast Augmentation.

Correcting the problem of implant mal-position or bottoming-out involves tightening the implant capsule with sutures ("Capsulorraphy" or "Capsulopexy"), sometimes with a flap of tissue from the inside of the implant pocket. Heavy, large implants may make this a chronic problem, however.

Los Angeles Plastic Surgeon
5.0 out of 5 stars 6 reviews

Are You "Bottoming Out?"

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"Bottoming out" is the term used to describe a downward malposition of a breast implant, below the natural breast crease:

  • the nipple seems to point upward
  • the breast seems too low
  • the upper pole of the breast lacks fullness
  • an inframammary scar (crease incision) will seem to "move" higher on the breast, farther above the crease

Do have your surgeon examine you to see if you are devloping a malposition that might require correction.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 46 reviews

South of the Border?

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It indeed sounds as if your implant on the left has gone south of the border. This may be due to the technical creation of the implant pocket during your surgery or the effects of gravity, (more common with larger, heavier implants). If there is a significant asymmetry compared to the opposite breast you should consider having it fixed with an internal repair of the pocket. Most surgeons will perform this procedure with minimal or no cost if within a year of the initial augmentation, especially if the condition was present immediately following your surgery and you have kept your surgeon aware of it. So, get back to your board certified plastic surgeon quickly. Good luck!

It might be, but we can't say for sure unless you are examined

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Hi Michelle. The above answers are accurate and I agree with all of them. "Bottoming out" does happen with larger implants and with gravity. However, if your incision has ALWAYS been "high" and your nipple appears slightly higher than the center of the implant, then it is likely that the space created for the implant (pocket) was too low. The only real way to answer you is to look at both breasts and determine the cause of the high incision. Seek out a qualified plastic surgeon in Indiana who can help. Good luck.

Sirish Maddali, MD
Portland Plastic Surgeon

It sounds like "bottoming out"

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If you have a reasonably large and heavy implant, the chance of it migrating south below your crease is higher. This is what is meant by the implant bottoming out. It can be corrected by repairing the pocket but if it is large, the problem may recur. If it was below the crease from the start, there may have been a problem with how the pocket was made.

You may be right

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Sometimes after breast augmentation, the implants "settle." However, as you state, your problem has "always" been there. It sounds to me more like your implant was malpositioned from the beginning. However, without examining you and seeing your pre- and post-op photos, it is hard to tell for sure. At this point, you will likely need a revision surgery to reposition the implant. This can be done through the same incisions (assuming you either had a infra-mammary fold or peri-areolar incision). During this surgery, be recreate the infra-mammary fold and/or lateral boarder of the implant pocket to hold the implant in the correct position. The recovery from this surgery should be much less involved than your original operation.

I hope this is helpful.

David Shafer, MD
Shafer Plastic Surgery - New York City

You are describing post breast augmentation ptosis

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Ptosis describes the sagging of a breast. Almost all woman with breasts will experience some form of ptosis during their lifetime. Gravity is the number one reason. Pregnancy is another cause.

As the breasts enlarge during pregnancy, the tissues stretch out and afterwards they will often not return to its original position. A third form of breast ptosis occurs as a result of the extra weight placed on the breasts from breast implants.

What you are describing is none of these things- it is postaugmentation ptosis. This is the sagging of the implant below the desired location. As a result, the nipples points upward, the inframammary folds become assymetrical, the inframammary scar will ride up on the breast and no longer be in the skin fold.

Many physicians suggest removing the implants, repairing the fold and then placing the implants back in at a later time. Others suggest using a foreign material (Alloderm, Gore-tex) as a splint to support the repair.

I suggest a novel technique that I have described in the medical literature called "an autologous internal breast splint". This technique takes the tissue from your pre-existing breast capsule to correct and preserve the impant in a better, more natural position.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews

Are you bottoming out?

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It is impossible to help you without an in person consultation or at least without any pictures. You should probably visit your plastic surgeon and share your concerns.

Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.
Bottoming out and Side Boobs Contributing Factors:
  1. Larger/Heavier Implants
  2. Implants placed above the pectoralis muscle
  3. Chronically not wearing a bra when upright
  4. Over dissection of the Implant Pocket
  5. Smooth Implants
  6. Large swings of weight including pregnancy
  7. Skin and soft tissue laxity, loss of elasticity

Likely: Your Implant Bottomed Out

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Your history suggests that your left breast implant has bottomed out.Unfortunately, without pictures or a physical examination, it’s impossible to confirm this diagnosis.
In someone who’s one year postoperative, this won’t get better on its own.For this reason, corrective surgery will be necessary.Correction will require a procedure known as a capsulorrhaphy.This procedure involves placing sutures in the lower breast pocket to raise the height of the inframammary fold.The procedures provides correction of the problem and is associated with high satisfaction rates.
If you’re concerned about implant malposition, it’s important to consult your plastic surgeon.Your surgeon should be able to formulate a plan that addresses your anatomic findings and achieves your aesthetic goals.

Bottoming out breast implants

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Based on what you have described in your question, it sounds like you are experiencing breast implants that have bottomed out. However, to be sure that your implant is bottoming out, you need to consult with your plastic surgeon so that he can examine the placement of your implant.

Bottoming out occurs when the breast implant falls below the natural, or surgically lowered, inframammary crease (the fold where your breasts meet your chest). In addition to the implants being positioned below the normal breast crease, you may also experience an upward tilt in your nipple and areola, and see your scar "move" higher on the breast above the crease. To correct bottoming out, a revision surgery is typically required. Your surgeon will explain which procedure is best for your particular situation. Good luck!

Jimmy S. Firouz, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 18 reviews

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.