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

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.

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.

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

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

Answers (8)

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Everything you need to know about Breast Implants

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