Are my implants bottoming out? (Photos)

Bottoming out is confirmed by comparing the implant position to the intended inframammary fold, not by projection alone. Across the side-view and front photos, the visible pattern is a heavy lower pole with stretched skin and a low-appearing fold, but an in-person exam is needed to confirm whether the implant has actually dropped below the planned crease.
Poor skin elasticity and an over-the-muscle pocket can make lower-pole stretch more likely. If the implant is stable and the fold is intact, time and support may be enough; if the fold has stretched or the pocket is too low, correction may require capsulorrhaphy/fold repair, an internal bra or mesh, implant size adjustment, or sometimes pocket conversion. A revision decision should be made after your surgeon checks the fold, nipple-to-fold distance, and scar/pocket strength.

Dear Reserved656314,

bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.

Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.

If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.


Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello, thank you for your question. Yes, you have poor skin quality and elasticity. That is why these implants are too large and heavy for you, and they have also ‘bottomed out’ due to their placement. It is necessary to replace them with smaller, lighter implants and, at the same time, to change their position.

Bottoming out refers to the descent of the implant below the level of the fold. A rising scar is often times a tell tale sign of a falling implant. A stargazing nipple is a similar sign as the breast mound autorotates upward as an implant slowly moves south. Based on your photos, you demonstrate signs of bottoming out: -Stargazing NAC -Lower sitting implant. In order to correct, surgical revision is necessary. It will include resetting the fold and potential addition of supportive mesh. Given the thin appearance of your skin envelope this seems likely. As always, discuss your concerns with a board certified plastic surgeon (ABPS)

Your implants are mildly bottomed out, probably due to a thin tissue envelope. In this situation, and internal bra with something like Galaflex is most effective, because it adds a layer of support.

Hello and thank you for your question! Yes, based on the photos, when the implants "overpower" the strength of the breast's natural tissues and breast fold (IMF), they start to drop lower than intended and lead to "bottoming out" - where the nipple looks like it is positioned too high "star-gazing" on the implant mound, although it is not technically too high from an anatomical measurement point of view (i.e. sternal notch-nipple distance, nipple position compared to the mid humerus/upper arm position). Larger, heavier implants can contribute to this along with weaker tissues, patients with a history of weight loss, etc. The correction for this issue is to reposition the implant and its pocket higher, elevating and reinforcing the IMF with sutures or sometimes the "internal bra" technique (absorbable mesh). Revision surgery is difficult and frustrating - I would start with your original surgeon to get their professional opinion before seeking other board certified plastic surgeons.

Yes your implants have bottomed out and surgical correction is needed for improvement. Placing the implants under the muscle may help so that the full weight of the implant is not being held by the skin alone. Bioabsorbable mesh may be helpful due to poor skin elasticity. Another option which can be used in conjunction with the other two is moving to a smaller implant. I've included a video that I hope you find helpful.

Based on your series, post of photos, there is a mild degree of bottoming of your breast implants. Surgical option would be revision of full breast lift with internal bra in combination with upper pole fat grafting. Fee $15,000-$25,000. Best of virtual consult with.