Should I down size due to bottoming out? (Photo)

I am having a revision on my 13 yr old saline under the muscle implants. I don't remember the exact CC's but my new PS is guessing they are around 350 CC's. My implants have bottomed out & I am having pocket repair, a lift & implant exchange. I'm sticking with saline implants due to cost. My ps doesn't think going down in size will make a difference with bottoming out reoccurring as the currently aren't 'Huge" implants. I am terrified they will bottom out again. Advice???

Doctor Answers 4

Bottomed out implants

Hello and thank you for the question and the photos. Your photos show classic bottoming out. This is both a physics problem and a biologic problem. Gravity, exercise running etc.. all put downward pressure on the implants. Over time, this problem affects a small % of patients. The second factor is biologic. How your body heals, how strong your scar tissue and capsule form are factors that keep the implant where it was originally placed. Sometimes this is a genetic issue and sometimes it's environmental / dietary. A healthy high protein diet is a good idea both before and after surgery. 

My recommendation: 

1. I would suggest a switch to textured gel implants. Textured implants do not move as much as smooth. gels actually weigh LESS than saline. 

2. Capsulorraphy: tighten the excess capsule and make sure the upper capsule is loose enough to accommodate the implant in a higher position. 

3. NO LIFT: Your nipple is already in correct position. A breast lift might make the nipple position TOO high, causing it to be exposed in normal clothing. The excess scars are not necessary. A breast lift is done when the patient has too much skin. That is NOT your problem. 

You should have several consultations with board certified plastic surgeons before making any final decisions. 

As always, best to be healthy, no smoking, and make sure any health conditions you have are managed by your primary care md.

Best to you.

Rockville Plastic Surgeon
4.8 out of 5 stars 21 reviews


Going with smaller implants will give less weight on your tissue and decrease the risk of bottoming out again. However, the important part is repairing the capsule and repositioning the implants.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.6 out of 5 stars 13 reviews

Bottoming out

Yes, it does look like your implants are bottoming. You would definitely benefit from a capsule repair. Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Should I down size due to bottoming out?

I am sorry to hear about  the complication you have experienced.  Your concerns regarding recurrence of breast implant displacement are certainly understandable.  I would suggest that you communicate your size goals carefully with your plastic surgeon (goal photographs can be very helpful in this regard) and ask him/her to  to get as close as possible to the  desired size, keeping SAFETY  and avoidance of complications as a first priority.

 In my practice, during the preoperative planning phase, I emphasize the need to keep our priorities in mind: correction of the breast implant displacement concern is of primary importance. Size concerns are secondary.   Again, in my practice, careful preoperative communication and the use of sizers during surgery help when it comes to selection of appropriate breast implants.  I use these temporary sizers once the breast implant pocket have been modified. The sizers also help confirm adequate correction of the implant displacement problem and breast symmetry.

 I hope this, and the attached link, helps. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,484 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.