Recurring bottoming out - how can I prevent this?

Question

I am 30 years old and just had my 4th breast revision 5 months ago, and am already experiencing bottoming out. My 1st breast aug also included a lift, and my most recent 2 have used the internal bra technique with Capsulorrhaphy I have 575cc implants placed over the muscle. I am unhappy with the result, but afraid of going through yet another surgery to end up in the same place. Suggestions? How do I know what implant size is right if I choose to downsize?

Richard Baxter, MD · Answer

I define the internal bra as the addition of a supportive material, just as an external bra. A capsulorrhaphy is not an internal bra, just a row of sutures - it's like a bra without a cup. Options for internal bra materials include Galaflex mesh and acellular dermal matrix such as Strattice. Larger implants like yours often need more support.

Daniel Barrett, MD · Answer

Dear Peaceful651080,

bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.

Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.

If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Guray Yesiladali, MD, FEBOPRAS · Answer

Recurrent bottoming out after several revisions usually indicates that the soft tissue has reached its mechanical limit. Each previous surgery weakens internal support, and large over-the-muscle implants place additional downward tension on already stretched tissue.
To achieve long-term stability, the plan often involves downsizing the implant and reconstructing stronger internal support. Moving the implant to a dual-plane (partly under the muscle) position or reinforcing the pocket with a biological or synthetic mesh can reduce stress on the lower pole.
Choosing the right size should not be based on cup numbers but on breast base width, tissue thickness, and skin elasticity. During surgery, temporary sizers help test the dimensions that provide fullness without excessive weight.
It’s completely understandable to hesitate after multiple operations, but thoughtful revision planning with smaller volume and reinforced support can often restore both confidence and comfort.
The goal is not just a smaller implant but a more stable and natural shape that your tissue can comfortably maintain over time.
Revision surgery can be emotionally and physically demanding, but with careful planning and gentle correction, it is possible to regain comfort and confidence again. I wish you patience and ease through your journey.Güray Yeşiladalı, MD

Camille Cash, MD · Answer

I'm sorry that you are having recurring issues with bottoming out.  This can happen when the implant is too heavy for the tissue.  Common ways to address it are adding bioabsorbable mesh to provide more support, decreasing the size of the implant, and placing the implant beneath the muscle.  Without photos or an exam it's difficult to give a recommendation for a specific implant.  The volume you mentioned is on the larger side, but may be appropriate based on your measurements.  I encourage you to visit with a few board certified plastic surgeons near you to listen to varying opinions.

Recurring bottoming out - how can I prevent this?

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