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

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.

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.

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.

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

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

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.

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.

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

this is a long term complication of all kind of breast reduction/lifting with or without implant surgeries. especially its more likely to seen in inferior pedicle techniques. we can reduce that risk with not to use inferior pedicle techniques, not to keep nipple-fold distance too long and make internal bra lifting with slight over correction.

Depending on the pedicle used for a reduction or lift, it is possible to have a bottoming out phenomena of your native breast tissue. An inferior based pedicel technique is more prone to this especially if the breast tissue is not anchored into place superiorly and if you happen to have loose, over stretched skin.