Please help! Am I bottoming out? (Photo)

600cc HP under implants crease incision. I think I may be bottoming out. My breast feel really bottom heavy, and I have this very achy, sharp constant pain under my left breast. a bra helps for a bit but the pain returns. It looks almost as if a corner of implant sticking out the bottom of my breast so the breast isn't round underneath. Also my breast completely seperate when ever I flex my peck muscles. It's really embarrassing is that something that can be fixed. Please help!

Doctor Answers 17

Bottoming out


Unfortunately, you are exhibiting the signs and symptoms of bottoming out.  This can be a problem for large smooth implants. You'll need to have a capsulorrhaphy performed, a procedure that uses sutures to close off the part of the pocket that is too large. Given your large implant size and the amount of pressure they exert, it may be a good idea to reinforce this closure with a biologic mesh (Flex HD or Seri) or an ADM (Alloderm or Strattice).

Best of luck!

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

Are you bottoming out?

You should make an appointment with your surgeon for an in person consultation. If you are bottoming out then here is some information which could help you.

Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.
Bottoming out and Side Boobs Contributing Factors:
  1. Larger/Heavier Implants
  2. Implants placed above the pectoralis muscle
  3. Chronically not wearing a bra when upright
  4. Over dissection of the Implant Pocket
  5. Smooth Implants
  6. Large swings of weight including pregnancy
  7. Skin and soft tissue laxity, loss of elasticity

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Bottoming out?

Based solely on your photos, you look as if, yes, you are bottoming out. Schedule an appointment with your surgeon to be assessed in person and talk revision options. Best, Dr. Nazarian

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Bottoming out

Thank you for your question.  There are actually multiple options to treat bottoming out but often additional surgery is required.  I would recommend discussing the options with your PS.

William Andrade, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 62 reviews

Bottomed out?

Thank you for your question and photos.  It appears that your implant is slightly bottomed out.  I recommend being seen in person by your operating surgeon to both confirm this and decide what would be the best plan of action. 

All the best,

Dr. Results
Miami, FL

Jose M. Soler-Baillo, MD
Miami Plastic Surgeon
4.7 out of 5 stars 92 reviews

Capsulorrhaphy and added tissue to bolster the repair

Thanks for your question. This is common with large smooth implants. As previously stated, you should seek consultation witha board certified plastic surgeon who is comfortable with revision breast surgery. Capsulorrhaphy should be performed with possible use of a reinforcement material like acellular dermis to help bolster the lower breast. With large implants and thin breast tissue, the lower pole tissues become very attenuated and the capsule repairs often don't hold without extra help. You could also consider slightly smaller implants also.

Wesley G. Schooler, MD
Santa Barbara Plastic Surgeon
4.8 out of 5 stars 17 reviews

Yes Bottomed Out

From the pictures you've included, it does appear that you have bottomed out. You have a very large gel implant which has stretched the bottom of the pocket due to gravity. You're also probably feeling the bottom of the implant through the thin amount of breast tissue that you have. I would recommend that not only a capsulorraphy but also adding of some kind of acellular dermal matrix which is less likely to stretch given the same weight that it has to carry then your intrinsic capsule. I recommend you go back to your operating surgeon to discuss. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Bottoming Out?

Thank you for your question. I'm sorry that you are experiencing problems. "Bottoming out" describes a condition where the lower breast skin stretches excessively allowing the implant to follow gravity and move downward.  This happens when the skin is overly stretched by too large of an implant. The nipple remains in its normal position; but because the breast is now longer, the nipple appears higher. This can be distressing, especially in severe cases where the nipple would not be covered by a bra or swim top. 

The condition can be helped, but I agree with Dr. Esmailian below, that you would have to decrease implant size. Correction might involve "tightening" the skin of the lower breast and possibly the use of a biosynthetic matrix to support the implant. Please make sure your surgeon is board certified and has an expertise in breast revision surgery. Good luck to you.

William McClure, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 5 reviews

Yes to bottoming out

Yes u do have bottoming out  !Looking at your pictures it appears the lower pole of your breast has stretched likely due to the size of the implants. Wearing a supportive bra that takes tension off the skin may help a little.  The rippling your feel will continue to increase as more of the implant is below the muscle. Fortunately this can be helped by using some supportive matrix on the inside to hold up the implant and to down size the implants. I hope this helps!

Ritu Chopra MD

Ritu Chopra, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 33 reviews

Bottoming out

You do appear to be bottoming out.  This is probably because you have large implants, thin skin and it appears your crease was lowered a bit to accommodate the larger implant.  It is fixable.  You will need to have the crease area tightened and lifted with a capsulorrhaphy or internal plication procedure.  Speak with your surgeon about this and get his opinion.  Best of luck!

Thomas Taylor, MD, FACS
Pasadena, CA

Thomas S. Taylor, MD, FACS
Pasadena Plastic Surgeon
5.0 out of 5 stars 10 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.