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

bottoming out, capsule, breast augmentation, breast lift

Doctor Answers 7

Bottoming out

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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

Bottoming out of implants

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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

Breast implants

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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.

Simona V. Pautler, MD
Pittsburgh Plastic Surgeon

Bottoming out

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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.

Bottoming out

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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.

Bottoming Out of Breast Implants?

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Thank you for the question.

Generally, breast implants will fully “settle”  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.

Bottoming timing is varible

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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.


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.