Bottomed out? What is this and how it could be fixed? (Photo)

I had replaced Natrelle 325cc smooth with 469cc textured.It's been 2 months since my surgery.Right implant is below the crease and I have discomfort.When I lay down it's even worse.If I push the right implant slightly in and up with my hand then they look the same. The first 2pictures are with my old implants and the rest are with the new implants.In the first 8 pictures my left breast is on the left side of the pic,in the last 5 pictures my right breast is on the left side of the pic.

Doctor Answers 4

Bottomed out? What is this and how it could be fixed?

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The term "Bottoming Out" is given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.
Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant.
This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold. Your board-certified plastic surgeon will discuss which approach is best suitable for you based your current implants.

Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Bottomed out? What is this and how it could be fixed?

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I am sorry to hear about/see the problems you are having after revisionary breast augmentation surgery. I think your concerns are  appropriate; one of your breast implants• does seem to sit relatively low on your chest wall, consistent with mild breast implant displacement ("bottoming out”).


Given your discomfort and concerns about breast asymmetry, I think 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.   

Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery.  

I hope this, and the attached link, helps.

Bottomed out? What is this and how it could be fixed?

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To fit a larger implant it requires a larger pocket.  It is possible that the crease was lowered to allow the implant to fit properly.  If one crease is lower than the other then this may require a repair. I would allow at least 6 months to see how they both sit over time.  If the difference is minimal, I wouldn't suggest a reoperation unless you absolutely have to have it.  Every operation carries risks, and these could be devastating. 

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Bottom out

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Indeed you have a nice result from your revision.  The right side is slightly lower and this is common as there are degrees of settling to implants.  There is a procedure to raise the right sided implant which is called a capsulorrhaphy.  The decision to pursue that revision is up to you and your surgeon.  Remember that every procedure has associated risks and a strong case could be made to accept the results as they are now.

Hope this helps.

Dr. Ali Mosharrafa

Ali Mosharrafa, MD
Phoenix Plastic Surgeon
4.9 out of 5 stars 16 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.