Worried I am bottoming out? (Photos)

I'm 5 weeks and 4 days post op My left breast has been lower then the right for almost two weeks now. The incisions under the crease I've noticed are slightly off one is higher than the other as well as my nipples. I've experienced no pain massage them regularly and wear sports bras. Frightened I might be bottoming out and will be needing revision surgery in the near future. Is it possible my left breast is dropping quicker and the incision was made a little bit higher very right breast?

Doctor Answers 14

Bottoming out?

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Thank you for your question and photos. It does appear that you have some bottoming out on the right. Wearing a support bra and/or a breat strap underneath may help. If there is still bottoming out after 6 months, you may have to have a revision with an internal suture repair of the breat fold to achieve better symmetry. Good luck!

Bottoming out

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Although it is very early, you do appear to have bottoming out.  At this point in your recovery, it is much too soon to be worried about the outcome.  It takes time for the implants to settle into position and the skin and muscle to stretch out to accommodate the new implant.  It may be 6 months or more before the shape has reached its final look.  Be patient.

Bottomming Out

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Hello,Thank you for your question and photos. Based on the photos provided it does appear that your right breast fold may be compromised. You need to have this evaluated in person to take next steps.
All the best

Bottoming out

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I would need to see the pre op photos - if you have sleected very large implants say more than 450 cc this problem can be more of an issue - you need to strap tha underside crease of the breast for another 6 weeks plus use a support bra - it may be necessary to revise the lower pole later if it continues

Bottoming out

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certainly, the preop photos are a necessity to evaluate this completely. but the photos do tend to indicate that you are bottoming out. there are things to do about this, to minimize the long term position. you need to talk to your BCPS. i would recommend a very tight bra support around the thorax area near the bottom of your breast, e.g.-- if you are a 34 than try a 32 or smaller to help keep the implants up. 

Breast augmentation

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Thank you for your question and photograph.It is important to address any post-operative concerns with your plastic surgeon.  You are still early on in your recovery and swelling after a breast augmentation occurs with 100% of patients, eventually the swelling will go down and your breasts will drop into their pockets. Sometimes, the swelling will resolve quicker in one breast than the other or one breast my drop quicker causing the appearance of unevenness. This is completely normal. If a breast is sitting too high, the use of a breast binder is beneficial to add downward pressure. I would continue to wear your surgical bra and perform your breast massages. Your doctor may also prescribe you a Medrol dose pack (steroid) to help with the swelling. If you continue to bottom out then this can be surgically corrected with suturing to add more support. I hope this helps.
Best of luck in your recovery!
Sincerely, James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

Botttoming out

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I would wear really good support for the next few months ,so it does not progress. if at 6 months you do not like the look , then have it corrected

Jonathan Saunders, MD
Newark Plastic Surgeon

Bottoming out

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If the inframammary fold attachments to the chest wall are dissected, a heavy implant may tend to bottom out.  The revision would involve reestablishing this fold with a suture repair for adequate support.  Best wishes, Dr. T. 

Bottoming out after breast surgery

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Thank you for your question and the photographs.Based on your photographs you appear to have some degree of asymmetry between the breasts.  Since you are still in a relatively early phase of healing, mild differences can be normal and expected.  Performing the correct breast massage, wearing the proper type and fitted postoperative bra, and avoiding strenous exertional activities are all important considerations at this stage of your recovery.  Comparing your before and after photographs is also very helpful in determining what changes are normal and those that are undesireable.I would recommend consulting with your Plastic Surgeon regarding your concerns.  Remember, you paid your Plastic Surgeon to perform your surgery AND to manage your recovery!

Concerns about "bottoming out"

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Thank you for your question and photos.

It is very important to have an in-person exam of your breasts along with clear before and after pictures from multiple angles in order to address your concerns. It could very well be that your breasts were like this immediately after surgery, and may not have changed much, or, it could be that your breasts did change.

Please note that it is not uncommon for breasts to heal and adapt to implants at different rates.

As you are currently in the early recovery phase, you will have to wait 3-6 months for implants to settle and for your breasts to achieve final results.

That being said, from the image provided it does appear that your right breast’s inframammary incision is visible but we don’t know if it really has moved up. If the incision really has moved up, this would indicate initial phases of bottoming out. We can also see that both breasts appear lower on the chest.

Here is some information about bottoming out that may help you understand it and be on the lookout for further signs.
  • Bottoming out is common when the inframammary fold is released and not firmly sealed and reinforced.
  • A weak inframammary fold will result in downward breast implant displacement once the breast implant slips below the natural or surgically lowered inframammary crease overtime.
  • Bottomed out implants end up too low on the chest wall with the inframammary scars travelling up onto the breast skin.
  • The nipples will not only point upward, but also be positioned higher on the breast mounds.
  • There will be no pain, but you may notice thinning of the skin at the bottom of the breast, which will allow you to more easily feel the breast implant.

It is good that you are wearing supportive bras as this prevent bottoming out from applying upward pressure to the fold at the bottom of the breast.

To correct “bottomed out” breasts, a surgeon would need to secure the implant in an elevated position and then reinforce the implant capsule at the bottom of the breast with a suture technique. There may be a need for Acellular Dermal Matrix, a soft-tissue graft, in the repair. A smaller implant is often advisable, if the original was too large. In fact, receiving an implant larger than indicated by your breast characteristics and boundaries increases the risk of malposition. 

Please continue to have regular follow-ups with your surgeon to make sure your breasts are healing beautifully. Their recovery instructions should take precedence over all else you read here as they are better informed about your surgical details.

Hope this helps.

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.