Is my implant bottoming out?? (photo)

I had a breast augmentation 4.5 months ago (425cc) I noticed 2 days ago that my right implant seems to be sitting lower than my left and feels a lot softer than my left it also feels much heavier the bottom right hand side...

Doctor Answers 13

Post breast augmentation defirmity

Dear MEH,

    Thanks for submitting your picture. From observing your picture, the following is noticed :

   1. Wide cleavage.

   2. Left breast moderate capsule contracture.

   3.  Right breast moderate bottoming out.

   All these problems can be improved conservatively. Wearing a bra with a wire, might raise the left crease and implants displacement massage can improve on the cleavage ,  lower the left crease slightly and soften the breast. 

   If after 2-3 months of conservative management , no improvement occurs and you are unhappy with your outcome, discuss with your surgeon the possibility of corrective surgery - left capsulotomy (scar release) and right inferior capsulorrhaphy (internal bra ).

    Always, consult with experience board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.

                          Best of luck,

                                           Dr Widder


McLean Plastic Surgeon
4.8 out of 5 stars 122 reviews

Bottoming out

"Bottoming out" refers to the implant dropping down lower on the chest wall, which creates the inframammary fold where the breast meets the chest wall (IMF) to look lower, the nipple appears higher, and the volume in the upper portion of the breast seems less.  The reason that surgeons are asking for preoperative photos, is that many people start with some degree of asymmetry.  Often one IMF starts lower than the other.  Often one nipple naturally sits slightly lower than the other.  Also, when implants are first put it, it takes several months for the implants to "settle" into their final resting place.  Usually this occurs in about 3 months, but it can take slightly longer.  The implants do not always settle at the same rate, so there is sometimes some temporary asymmetry.  Your asymmetry is relatively mild, but it is present. If you have preoperative photos, or if you have photos from prior to the "dropping sensation" of the right breast, you might look to see if you were asymmetrical before.  Certainly this would warrant a visit to your original surgeon, who is most familiar with you and likely has preoperative photos. Good luck!

Kirsty Boyd, MD, FRCSC
Ottawa Plastic Surgeon
5.0 out of 5 stars 2 reviews

Breast augmentation - recent change in right implant

Thank you for asking about your breast augmentation.

  • I understand your concern -
  • It is hard to be sure from the one photo but you do appear to be bottoming out -
  • There is less volume above the nipple on the side causing you concern.
  • You need to return to your plastic surgeon for an exam and discussion of what is going how and what the approach should be.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Not necessarily

A pre-operative picture would be helpful.  Breasts (like the rest of our bodies) are notoriously asymmetric and it is conceivable that fold was lower to begin with. Breast augmentation can spotlight those asymmetries.  That being said, it could be the beginnings of inferior implant malposition.  Check in with your PS.

Andrew Gear, MD
Charlotte Plastic Surgeon
5.0 out of 5 stars 15 reviews

Implants

There is always some asymmetry between the two breasts and each one may feel a bit differently.  I do not see bottoming out. An exam and comparison to preops would be reasonable. I am guessing they were similar before surgery too.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 25 reviews

Is my implant bottoming out??

Thank you for sharing your question and photograph.  Unfortunately without preoperative photographs and additional images of your current appearance, it is difficult to know if your implant is bottoming out.  I would see your surgeon for an in-person examination and definite diagnosis. Best wishes.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 50 reviews

Probably bottoming out

Sorry to hear that you are going through this.  While it is of course impossible to say without an exam (as noted by the other docs here) this implant does look to be bottoming out.  The implant is sitting lower, the nipple appears relatively higher.  From your photo I would bet (although anything is possible) that you were relatively symmetric preoperatively.  Typically this will not get better on its own and will need a revision in order to lift the implant back up and tighten the pocket.  While it is more surgery it is a relatively straight forward repair.  Best of luck!

Evan Sorokin, MD
Cherry Hill Plastic Surgeon
4.8 out of 5 stars 75 reviews

Bottoming Out?

Thanks for posting your concerns. I cannot tell if there's actual bottoming out from the photo posted. I do agree that right is slightly lower but this does not appear to be serious enough to consider it bottoming of the breast implant. Perhaps a look at your before photos would be helpful! Best, 

Dr. ALDO

Aldo Guerra, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 198 reviews

Is my implant bottoming out?? (photo)

Hard to tell with the photo you posted. Remember that no two breasts ever look the same or heal at the same rate. Best to follow up with your operating surgeon so he or she can directly address your concerns. Good luck!

Farah Naz Khan, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 89 reviews

Signing of Bottoming out

Thank you for your question and photos.

It is very important to have an in-person exam of your breasts along with clear before and after pictures from multiple angles in order to address your concerns.

Here is some information about bottoming out that may help you understand it and be on the lookout for further signs.

·         Bottoming out is common when the inframammary fold is released and not firmly sealed and reinforced.

·         A weak inframammary fold will result in downward breast implant displacement once the breast implant slips below the natural or surgically lowered inframammary crease overtime.

·         Bottomed out implants end up too low on the chest wall with the inframammary scars travelling up onto the breast skin.

·         The nipples will not only point upward, but also be positioned higher on the breast mounds.

·         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.

It is good that you are wearing supportive bras as this prevents bottoming out from applying upward pressure to the fold at the bottom of the breast.

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. 

Please continue to have regular follow-ups with your surgeon to make sure your breasts are healing beautifully. Their recovery instructions should take precedence over all else you read here as they are better informed about your surgical details.

Hope this helps

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 443 reviews

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.