Am I bottoming out? (Photos)

Hi there, I am currently 4 months post op and my right breast is sitting a lot lower than my right. I've attached two pics, the bottom pic is 2 months post op - they were very even. And top pic is 4 months post op. Have i bottomed out? Or are they just dropping at different rates? And if so, will they ever be even?

Doctor Answers 9

Bottoming out with Breast Augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

From your photo, it does appear that you have bottomed out on one side. The breast now has a "double bubble" deformity with the crease likely being lowered on that side. This can be fixed with a second procedure where the internal capsule is tightened to help restore your original anatomy. 

You should see a board certified plastic surgeon in your area to get a formal opinion through an in-person consultation.

Best of luck,

Vincent Marin, MD

San Diego Plastic Surgeon

San Diego Plastic Surgeon
5.0 out of 5 stars 52 reviews

Bottoming out

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It appears to me that you are bottoming out on the left side. It may or may not get worse over time. The treatment is surgical. I suggest you return to your surgeon but be sure you are seeing a board certified Plastic Surgeon.

William H. Gorman, MD
Austin Plastic Surgeon
4.0 out of 5 stars 19 reviews

Bottoming out after breast augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

hi - from your most recent picture there does seem to be a difference and the left implant may well be sitting lower than the right.  There are many causes for this which may be related to any pre operative difference between the breasts. I would recommend you visit your surgeon for an examination and to discuss any surgical options to correct this. 

Implant malposition

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your left implant has migrated below the the inframammary fold.  It can be fixed with either a capsulorraphy or a neopectoral pocket (my favored approach).

Andrew Gear, MD
Charlotte Plastic Surgeon
5.0 out of 5 stars 29 reviews

Bottoming out

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your breasts area clearly changing with time and there is some fold asymmetry.  Whether this is true bottoming out is not clear from the photos.  I think I can see yours scars which have not changed in position (with real bottoming out the scar usually rises on the breast mound).  I would recommend wearing a suppportive bra and following up with your surgeon to discuss this.  

William Koenig, MD
Rochester Plastic Surgeon
4.9 out of 5 stars 72 reviews

Bottoming out

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hello, it does look like one implant is lower than the other but your surgeon will be the best source of advice on the cause of the asymmetry.  They will have examined your breasts preoperatively and will be able to determine whether any pre-existing difference in the breasts is contributing to the current appearance.

Pocket expansion

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It looks as though your left breast (in the photo) is sitting lower, in a manner compatible with pocket expansion.  It will likely require a procedure known as pocket plication or capsulorrhaphy to repair it.  This is done with internal sutures, and works 80%+ of the time.  Best to discuss with your original surgeon.

Best wishes,

Am I bottoming out?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are appropriate; one of the breast implants does seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”). Also, consistent with the breast implant positioning problem, the nipple areola complexes seem to be sitting relatively high, because the breast implant has settled too low. 

I think it is possible that you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair).  This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation. 


Your plastic surgeon will be your best resource when it comes to accurate assessment and advice. I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.

Uneven breasts 4 months post-op are partially due to "bottoming out"

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

G'day and thanks for posting your question!   Before I begin, I want to get our bearings for accuracy, because in your description you mentioned that "my right breast is sitting a lot lower than my right," so things are a bit confusing as they are now.  From the looks of the image that you show, it appears as though this is a picture taken in a mirror, which would mean that your right breast is the one on the RIGHT side of the image, and thus your description would have read:  "my right breast is sitting a lot lower than my left."  Let's assume that this is the way it is at least for the sake of our discussion, so that we'll be on the same page.  Additionally, since there are two images taken at two different times, it’s worth noting that the two images appear to have the same orientation, although, without any identifying marks like moles or tattoos, it is difficult to assure that here as well, so let's assume that it is the case too.  In that case, it appears as though the right breast has indeed migrated downward a bit since surgery.  If this is so, we would refer to this as "bottoming out."  Before I say any more about that though, I also want to point out one other thing which will segue into the discussion about bottoming out.  It also appears as though even on your earlier image you had a faint hint of a "double bubble," or double contour.  This implies that your inframammary fold was lowered (appropriately, given the resultant good nipple position) in order to accommodate the size of implants that you selected.  In this image, we can see the contour of the bottom of the implant at the new inframammary fold, but we can also see the faint hint of a contour crossing the lower portion of the breast, and this is where the natural breast tissue ends and the old inframammary fold used to be.  In order to “fit” the implant to create the “new, larger sized” breast mound, that old fold had to be “lifted up” to allow the implant to be positioned lower.  This is where we begin to have a problem with double contours and possible bottoming out.  If the tissues of the lower breast are managed properly, and the layers of the fatty tissue below the new fold are properly secured, this situation can often be prevented, or at least minimized.  Relaxing the tight tissues of the original fold internally and repositioning and securing the lower breast tissues often allows the implant to “stretch” them, and the differences in thickness will often smooth out, lessening the risk of double bubble.  If the fatty tissue below the new fold is not secured properly at the new fold, too, the implant can then force its way behind the tissues along the body wall, and it will gradually drift downward, creating the asymmetry that you see and the condition we recognize as “bottoming out.”  Many times this happens on one side more than the other because women have natural asymmetry in the breasts necessitating slightly different techniques between them.  At this point 4 months after your surgery, it is likely that things are now stable and should not change much more.  This would be a good time to discuss these issues with your surgeon in person to get his or her assessment of it and what to do going forward.  He or she will be the best equipped to give you advice about this as he or she did the original procedure and is there to examine you in person now.  Don’t lose hope though, as this happens from time to time with breast augmentation, and there are definitely ways to fix it.  Best of luck!

Joseph L. Grzeskiewicz, MD
San Diego 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.