Bottoming out - Can this happen after a breast reduction / lift without implants?

Question

Is it only possible to bottom out with implants? Or is that something that can occur with a breast reduction/lift with no implants?

Semih Yildiz, MD, FEBOPRAS · Answer

The term “bottoming out” is most often used with implants, when the implant sits too low or the lower breast pocket stretches. A similar lower-pole descent can also happen after a breast reduction or lift without implants, but the mechanism is different.

After a reduction/lift, the lower breast skin and internal support can stretch over time, especially with heavier breast tissue, thin skin, weight changes, pregnancy, or weaker tissue quality. This may make the nipple look relatively high while the lower breast looks longer or heavier. It is not exactly implant bottoming out, but patients may describe the appearance in a similar way. If it occurs, revision options may include tightening the lower pole, reshaping the breast, adjusting scars, or adding internal support depending on the anatomy and timing from surgery.

Zoran Potparic, MD · Answer

This deformity may happen frequently after reduction of large breasts, regardless of the technique used. If too much breast tissue is left in the breast, in time, due to gravity, heavy breast tissue will descent in the lower pole of breast, stretch a weak skin envelope and create bottoming out deformity. Hope this helps.

Michael J. Stein, MD, FACS · Answer

Great Question. 
Bottoming out is a relatively common problems with implants. When the chosen implant is too big and/or the breast tissues cannot support the weight of the implant, the implant will shift downwards and the nipple will look too high. 
Ask your plastic surgeon about your tissue quality. Ask her/him if the size you are going for can be supported by your tissues. Meticulous measurements and choosing the right procedure and materials during breast augmentation should prevent this complication from happening.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question regarding bottoming out of the breast.

It would be helpful to have photos to see exactly what your breast look like.

If you are having concerns after surgery, I recommend that you speak with your surgeon or someone on his staff.

Jose A. Munoz, MD · Answer

Hi and welcome to our forum!"Bottoming out" is a term used to describe a complication of breast augmentation (with an implant) in which the inframammary fold descends downward usually due to weak musculature / stretched out skin or after the use of an excessively large implant.Pseudoptosis is a condition which may be caused by stretched out breast skin and residual soft tissue resulting in excess breast tissue in the inferior poles of the breast. This is not an infrequent complication of breast reduction and can be corrected surgically. 15% of cosmetic surgeries can be improved with a secondary touch-up procedure.Revisit your plastic surgeon.Best wishes...

Ronald J. Edelson, MD · Answer

This is common after breast reduction. The skin in the lower part stretches out. It can be revised by tightening the skin in the lower portion or the breast

Daniel Barrett, MD · Answer

Dear Fantastic68921,
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.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Wess Cohen, MD · Answer

Thank you for your question. Yes bottoming out can happen without implants. This is when the breast tissue falls to the lower part of the breast. This will naturally happen to some extent, regardless of the procedure as gravity will always have an effect.

James Knoetgen, III, MD · Answer

Bottoming out is a term typically associated with breast implants when the implant descends too low on the chest, causing the nipple to appear too high. However, in the context of a breast reduction or lift without implants, a similar issue can occur, though it's less common and presents differently.
Can Bottoming Out Happen Without Implants?
Yes, but it's not the same as with implants. In a breast reduction or lift, bottoming out refers to the lower pole of the breast stretching over time, leading to sagging or an imbalance in breast shape. This can happen due to factors such as:
•	Weak skin quality (loss of elasticity)
•	Gravity and natural tissue descent over time
•	Inadequate internal support during surgery
•	Healing complications like poor scar formation
•	Large, heavy natural breast tissue that continues to pull downward
How Does It Compare to Bottoming Out with Implants?
With implants, bottoming out occurs because the implant shifts downward, which can sometimes be corrected with surgical revision. Without implants, the issue is more about soft tissue settling and stretching rather than implant displacement.
Prevention and Treatment
•	A well-executed internal bra technique or suturing methods during surgery can help provide long-term support.
•	Wearing a supportive bra consistently during healing and beyond can help slow the effects of gravity.
•	In severe cases, a revision surgery with additional tissue support (such as mesh or internal sutures) may be needed.

Anne-Sophie Lessard, MD · Answer

Yes unfortunately, bottoming out can happen with breast reduction/lift over time, even if no implants were used.

Bottoming out - Can this happen after a breast reduction / lift without implants?

Answers (13)

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