Does risk of "bottoming out" increase if I start with very little breast tissue?
Doctor Answers 16
Yes and No
Women with small breasts tend to have larger breast implants inserted. The larger the implant, the greater the tendency for the breast tissues to stretch and for either the implant to drop or for the skin to stretch excessively. On the other hand, you are selecting a small implant. If the inframammary incision is used but the surgeon places supporting sutures that reinforce the wound closure, you should be fine.
Bottoms Up with the Underneath Incision
Your surgeon was probably confusing this term with "inferior malposition," which is what happens when the implant drops below the crease underneath the breast (the so-called inframammary fold or IMF.) This can happen for a few reasons: imprecise technique, a poorly defined crease before surgery, a crease that is too high before surgery that needs to be lowered, a large and heavy implant putting pressure on the crease, and weak tissues. Often more than one of these is responsible.This can happen with large and small breasts. Small breasts are not more at risk unless you are planning on putting in a large implant which will require substantially lowering the crease under your breasts and your tissue is weak. For your height and weight the implant you are planning upon does not sound unreasonable, but unless your breast is properly measured and evaluated it is impossible to know for sure. It may be that you need an implant less than 200 cc.They are also incorrect about the underneath incision contributing more to this problem. Published studies show that there is a lower rate of implants being out of position with the underneath incision than any other incision. It is the overwhelming preference of surgeons worldwide.I would suggest you find someone who better understands proper breast terminology and the mechanism of inferior malposition.The link to my website below discusses implant malposition.
Bottoming out due to Minimal breast tissue?
Having limited breast tissue alone is not a cause for bottoming out, but you would be more likely to have bottoming out when the inframammary fold is released and not firmly sealed and reinforced. The problem is that women with minimal breast tissue often do not have a defined crease which is why creating a pocket without releasing it can be difficult.
Bottoming out is also known as breast implant displacement and it results from the failure of the implant pocket where the breast implant slips below the natural or surgically lowered inframammary crease overtime.
A pocket can fail when there is loss of internal tissue support at the bottom half of the breast and this may lead to the breast implant to move downward on the chest, gradually lowering the natural bottom (crease fold) of the breast.
Clinical signs will include the implants ending up too low on the chest wall, the nipples will not only tilt upward as the breast implant heads down, but also be positioned higher on the breast mounds. Unfortunately, any inframammary scars from breast augmentation may travel up the lower breast mound. There will be no pain, but you may notice thinning of the skin at the bottom of the breast, which will allow you to more easily feel the breast implant.
An adequately created pocket can prevent this from happening. Also using the peri-areolar or transaxillary incision will prevent direct manipulation of the inframammary fold. After surgery, wearing a supportive underwire bra that applies pressure to the fold at the bottom of the breast may help prevent bottoming out.
To correct “bottomed out” breasts, a surgeon would need to secure the implant in an elevated position and then reinforce the implant capsule at the bottom of the breast with a suture technique. There may be a need for Acellular Dermal Matrix, a soft-tissue graft, in the repair. A smaller implant is often advisable, if the original was too large. In fact, receiving an implant larger than indicated by your breast characteristics and boundaries increases the risk of malposition.
If you are comfortable with your surgeon and trust his opinion, take his advice. If you are a skeptical, then it is not wrong to get a second opinion before making your decision.
Hope this helps!
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Position of scar in the inframammary fold
Thank you for the query. You are obviously slim and looking for an appropriate size breast implant under the muscle. I would have thought that the fold incision is absolutely reasonable as this is the commonest approach. You may need the fold incision to be anchored to deeper tissue to maintain this area and it does work.
Sometimes if the tissue is very thin, one can feel the implant through the thin tissue on the lower part of the breast but this does not tend to be a major issue.
I would suggest having another detailed discussion with your surgeon to identify this matter before moving forwards.
Preventing bottoming out
Bottoming out has nothing to do with what incision is used
The amount of breast tissue that you begin with won't necessarily affect your risk of bottoming out. Surgical technique, including careful selection of implant size and dissection of the breast pocket are factors. If your Plastic Surgeon must lower or create a breast fold for you they will be concerned about reinforcing that area to prevent malposition. This is important and it could become a point of weakness if not handled carefully. I recommend that you discuss these considerations further with your chosen Plastic Surgeon.
All the best