Please help! Am I bottoming out? (Photo)
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Doctor Answers 17
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!
Are you bottoming out?
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:
- Larger/Heavier Implants
- Implants placed above the pectoralis muscle
- Chronically not wearing a bra when upright
- Over dissection of the Implant Pocket
- Smooth Implants
- Large swings of weight including pregnancy
- Skin and soft tissue laxity, loss of elasticity
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All the best,
Capsulorrhaphy and added tissue to bolster the repair
Yes Bottomed 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.
Yes to bottoming out
Ritu Chopra MD
Thomas Taylor, MD, FACS
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.