Am I bottoming out or am I just over paranoid? (Photos)

I feel like my nipples are sitting high. People say they do look pretty high but I don't know? Some say they look great, others say they sit high... If I am Bottoming out, what can I do to fix this?

Doctor Answers 16

You are not paranoid and your nipples should not be pointing up at they sky

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and I'm sorry you are experiencing this.  Wear a supportive bra and discuss your concerns with your surgeon.  If your surgeon says its all fine and good, be patient but when it comes to evaluating your results and your surgeon still says they are fine and good, your surgeon is not being honest with you.  Your lower poles are way too long and you can document your journey by measuring the distance from your nipple to your fold and if lengthening, bottoming out is happening.  If stable, your implants are positioned too low.  Regardless, you will need some kind of revision down the road from a transverse scar in your crease to attempting to elevate your folds.

Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Bottoming Out?

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It is difficult to say whether you are bottoming out without seeing your immediate post-op photographs with the implants in place. If the nipples looked high right after surgery then it suggests that the implants are placed in the breasts. However if the nipples were more centralized immediately following surgery, it suggests that both implants are coming down and giving that skygazer appearance to the nipples. Bilateral bottoming out is something unusual. I suspect that they are low. If it is a concern, you may choose to have a revision to the inframmary fold is reset a little higher surgically so that the implant sits higher in the breast relative to the nipple.

Bottomed Out

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Unfortunately, you are not being paranoid.  Your implants have objectively bottomed out, with nearly no implant above your nipple areolar complex, and your incisions an inch away from your inframammary fold. Your implants appear to be too large for your chest wall and possibly your soft tissues, and they are likely round and smooth. To get an improvement with your appearance, you will need a revision surgery. If your surgeon isn't an ABPS certified/ASAPS member who specializes in revision breast surgery, you should get a few second opinions. 

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Bottoming Out

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Based upon your photos, it does appear that you are bottoming out.

Bottoming out is characterized by the descent of the implant below the native fold. This is commonly encountered when an attempt is made to lower the fold (without adequate reinforcement afterwards). Patients will also note an upward migration of the IMF incision onto the lower pole of the breast as well an upward migration of the NAC (star-gazing areola). This may also at times be a function of excessive downward pressure on the tissue as in the case of an oversized implant.

This will not resolve on its own and can be progressive. Correction typically involves reinforcement of the fold either with capsule or a biologic scaffold. Patients may consider downsizing as appropriate.

As always, discuss your concerns with a board certified plastic surgeon.

Donovan Rosas, MD
Kissimmee Plastic Surgeon
5.0 out of 5 stars 13 reviews

Are my breast implants bottoming out or am I just over paranoid?

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Thank you for your question and photo.  Yes it does appear that your implants are bottoming out.  This can be revised but it will require a surgical revision of the breast implant pocket and reestablishment of the inframammary crease at an appropriate level.  Please see your plastic surgeon. For more information please read the link below:

Bottoming out

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Yes, as other surgeons have explained your implants have likely settled too low causing your nipple to be pointed up. Surgery is needed to correct this. If you infra-mammary crease had to be lowered during the initial surgery this can happen. Discuss your concerns with your surgeon. Best of luck

Josh Olson MD

Bottoming Out of Implants

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Hi Momma

Yes, you have bottomed out, both sides.  As a result, the scar has migrated up a bit, onto the lower pole of the breast.  Additionally, as the implant goes lower, it tends to make the nipples point up toward the ceiling.  The second image appears to also show synmastia.

You may either accept this, or if you want it corrected, it will be a trip to the operating room.

You will need to speak with your doctor.

Good luck to you.


Breast evaluation

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Hello and thank you for your question. Based on your photograph, your breasts demonstrate bottoming out.  The only way to fix this is with a surgical revision using an inferior sling such as Seri scaffold or strattice.  The good news is that it can definitely be fixed.  If your primary  surgeon does not have a lot of experience with this, then seek out an expert, who is board-certified by the American Board of Plastic Surgery.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 172 reviews

Bottomming out

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Thank you for your question. Pictures suggest bottoming out. You need a surgical revision to fix the problem and possibly smaller implant.Please talk to your surgeon

Implants are sitting too low

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Bottoming out is commonly what we call this situation. Your implants are positioned lower than ideal which causes the nipple to sit on the top of you breast ad opposed to in the middle. Surgical repair is needed to elevate the implant to a more natural position. Sometimes a smaller implant will be needed as well. I recommend discussing this with your surgeon to come up with an appropriate plan. Best wishes. 

Michael S. Hopkins, MD (retired)
Albuquerque Plastic Surgeon

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.