How Quickly Does Bottoming out Usually Occur? Is the Breast Secure Once the Capsule Has Formed?

Question

bottoming out, capsule, breast augmentation, breast lift

Larry S. Nichter, MD, MS, FACS · Answer

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 ImplantsImplants placed above the pectoralis muscleChronically not wearing a bra when uprightOver dissection of the Implant PocketSmooth ImplantsLarge swings of weight including pregnancySkin and soft tissue laxity, loss of elasticity

Simona V. Pautler, MD · Answer

Bottoming out can occur as quickly as a few months to a few years after surgery. It all depends on the patients breast tissue and skin elasticity. It is also impossible to accurately predict who will get it and who won't. Weight loss and pregnancy after augmentation can bring it on faster in those who have stretch prone tissue, and there is not much that you can do to prevent it if it's going to happen. Larger implants, greater than 350 cc, can increase the risk in those types of individuals. Usually these patients fail to make any capsule at all and are extremely soft and saggy. If the breasts form a capsule that is thick enough to support an implant, even a heavy one, then the implants may stay secure, however even in these patients weight loss and pregnancy can make the implants look a little lower. Every patient is different, some stretch more than others. Fortunately, there are techniques now available to correct stretch and bottoming out deformities that are extremely durable.

Steven Wallach, MD · Answer

Bottoming out with implants can happen with time or soon after surgery. This may be the result of violation of the inframammary fold or stretching of the soft tissues with time.

Ralph R. Garramone, MD · Answer

Bottoming out refers to excessive stretching of the skin and breast tissue of the lower part of the breast essentially from the nipple level to the level of the inframammary fold.

	This will occur more in patients with poor tissue elasticity and in patients with larger implants which tend to weigh more and put greater strain on this tissue.  It is important to wear a well supportive, preferably underwire, bra after a breast augmentation to help support the weight of the implant.

	The scar capsule may or may not help to support the weight of the implant.  Sometimes the capsule is quite thin and does not offer much support and in some cases the capsule is a bit more substantial and will support some of the implant weight.

	Another case for choosing a more conservative size implant.

	Thank you for your question.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Generally, breast implants will fully &ldquo;settle&rdquo;  and be in a stable position anywhere from 6 months to one year after surgery. Generally, if implant  malposition ( Including bottoming out)  is going to occur,  patients will see it within this time frame.

	In the longer term, breast implant malposition is still possible.  This may be related to the effects of time, gravity,  skin elasticity issues, weight gain and weight loss, pregnancy...

	Fortunately, breast implant malposition  issues can often be corrected with  capsulorrhaphy techniques.

	I hope this helps.

R. Morgan Davoudi, MD · Answer

The timing can vary, but most likely not to happen after a couple of years and the capsule thickness does contribute to preventing this unsatisfactory result. As your know, bottoming out is when the implant slips below the natural fold underneath the breast. It can happen from over-dissection by the plastic surgeon or a heavy implant in a patient with very thin and inelastic skin. Placement of implant underneath the muscle can also help prevent this problem. Correction requires reducing the size of the pocket (sawing the capsule together), putting a piece of cadaver or artificial skin inside the breast to better support and push the implant up, or doing a breast lift by removing the redundant skin from the bottom of the breast.

Jon F. Harrell, DO, FACS · Answer

Bottoming out is variable and this is because the size and weight of the implant can vary and the patient's skin and breast tissue may be either thin and relatively loose or tight. The development of the capsule may or may not affect this bottoming out process. In some patients the capsule is very thin and offers not resistance to the force of gravity. In other patients the capsule can be very thick and can even close off the lower portion of the implant pocket- moving the implant in an upward direction. In short each patient is unique and there are a number of forces working on the final position of the implant. Best of Luck Dr Harrell

Mahmood Kara, MD - Account Suspended · Answer

Thanks for your inquiry.

It generally takes around 6 months to a year to see your final results. Your tissues will take time to relax and allow your implants to "Drop and Fluff" settling into place. Should a revision cross your mind, it is best to wait at least 6 months to a year before doing so.

Our tips for recovery following breast augmentation are to wear a supportive sports bra for 3 months post-operative and refrain from lifting anything heavier than 10 lbs for 3 weeks as we don't want any strain at your incision sites. Make sure to keep the area of your stitches clean by cleansing with hydrogen peroxide daily. Showering is encouraged! But, no sitting in water for 2 weeks following surgery (no baths, hot tubs, pools etc.).

Please note that this response does not substitute patient-doctor relationship. We welcome any and all patients seeking advice to come in for a complimentary consultation available for limited time only.

During the COVID-19, we are offering complimentary online consultations as well as in-office consultation with social distancing and masks. Procedure done in-hospital private surgical facility while taking covid-19 precautions. We utilize UV-light to clean the air of viruses and bacteria during our consultations and surgery. We invite you to come in to discuss your options more thoroughly. Please send us an email at info@drkaraplasticsurgery.com with the subject line: "Attention Meagan" and we will be happy to coordinate your appointment!
M.Kara,MD,FRCSC (27+ years experience) - Specializing in 24 hour recovery/ out to dinner breast augmentation in-hospital private surgical facility for your added safety and peace of mind

How Quickly Does Bottoming out Usually Occur? Is the Breast Secure Once the Capsule Has Formed?

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