Bottoming out; do you need a internal bra or will tightening up the ottomans side poles work?

I am going in for my second revision because I have bottom out , I am switching from saline to textured silicone , the doctors is tightening up the bottom and side poles . I will also go smaller , I believe I had a 375 or 400, the doctors is going to drain my implant , I am now looking for a 325

Doctor Answers 9

Bottoming out

Bottoming out can be treated by repairing the capsule. I will often use a thong bra after surgery as well.  


New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Bottoming out of breast imlplants

Hi, 

I'm afraid reducing your implants by 50-75cc won't be sufficient to minimize a repeat revision. Your tissue has been stretched/injured to the point where it may not hold the repair. I strongly recommend you choose a smaller implant to gain stability. If not, you're risking another revision in the near future. 

Best, 

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.7 out of 5 stars 210 reviews

With textured anatomic implants

 precise pockets are needed to help it heal in place and not allow it to rotate.  If you're just going with textured round, I see absolutely no benefit to those implants and would avoid them, but that is my opinion.  The textured anatomic implants, when healed as desired, will not move and drop or shift so I think its best when dealing with a pocket that has descended excessively.  My patients have to wear a cut out underwire bra 24/7 (yes, that means in the shower) for 6-8 weeks to help remove the tension on the sutures used in diminishing the pocket size.  Good luck!

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

About Breast Implants "Bottoming Out"

"Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.
Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant.
This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold.

Your board-certified plastic surgeon will discuss which approach is best suitable for you based on your current implants.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

Bottoming out

Thank you for your question.  To fix "bottoming out", we use sutures alone to reconstruct the borders of the breast versus an "internal bra", which is typically a type of mesh.  There are obviously different costs associated with one versus the other.  Additionally, the failure or recurrence rate of the bottoming out is typically higher with just the suture repair, but this costs typically less for the patient.  

Brian C. Reuben, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 31 reviews

Bottoming out?

Bottoming out is caused by either the skin or capsule stretching out over the lower breast pole; Thus correction of bottoming out requires one or the other or both to be tightened; that's all there is to it; Please see examples below.

Arian Mowlavi, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 45 reviews

Implant bottoming out

Switching to a smaller implant will help a bit, but is not a necessity. There are several ways to correct bottoming out of an implant:

1. removing some or a lot of the capsule and adding texture to the implant

2. tightening or plication of the scar tissue capsule (capsulorraphy)

3. adding an internal bra (seri, strattice, galaflex)

Being your second revision, I would recommend adding one of the internal bra products. Galaflex is the least expensive, has few complications, and very effective; that would be my choice for you. Strattice works great, but is costly. Seri has too many published complications for me to recommend any longer. 

How Do I Correct Bottoming Out Of My Breast Implants?

There are two basic ways to approach a breast implant that has bottomed out.  One way is to tighten the capsule which surround the breast implant at the lower pole of the capsule.  This will raise the bottom of the capsule, a process known as capsulorraphy.  As a double protection on top of a capsulorraphy, one can place Seri.  This process is known as an internal bra.  The extra skin at the bottom of a bottomed out breast implant reattaches itself to the chest wall where it came from.  


An external correction of a bottomed out implant directly removes skin that is hanging too low, and therefore corrects the low positioned lower pole of the breast implant pocket.  At times, this is the best and most guaranteed method for correction of bottoming out, but it also leaves an extra scar.  


Your personal plastic surgeon is the best resource to help you determine which of these two techniques will work best for your situation.

Bottoming out; do you need a internal bra?

I am sorry to hear about the complications you have experienced.  Please do not let the semantics cause undue concern; the "internal bra" refers to a procedure where the breast implant capsule is "tightened up" (capsulorraphy).   In other words, the space around the breast implant is decreased in volume, thereby preventing movement of the breast implants into undesirable directions (for example bottoming out, lateral displacement, or symmastia). Sometimes, depending on the situation, additional supportive materials such as acellular dermal matrix or biosynthetic mesh may also be helpful.


 For your own peace of mind, clarify with your plastic surgeon exactly what is planned and what his/her success rate is with this type of revisionary breast surgery.  You may also find the attached link/review helpful to you. Best wishes for a successful outcome that you will be very pleased with.

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.