What is the Chance of Bottoming-out with Implant Via the Nipples?

Doctor Answers 9

Breast Implants Bottoming-Out

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Implants can bottom out no matter where the incision is done. The forming of the pocket more likely determines bottoming out.

San Antonio Plastic Surgeon
4.6 out of 5 stars 73 reviews

Bottoming out of implants

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Bottoming out of implants can occur from any approach to place implants.  It usually occurs with over dissection of the inframmary fold and sometimes in patients with poor tissue quality with large implants that stretch the lower portion of the breast.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 51 reviews

What is the Chance of Bottoming-out with Implant Via the Nipples?

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It can happen with any incision used however I personally think it is more possible with an infra-mammary incision due to the possible disruption of dermal attachments to the chest wall. I use the underarm approach almost exclusively and I RARELY see implants drop too low. I am also of the opinion that most women need their fold lowered to get the implant centered under the nipple but we do tend to use a bit bigger implant here in Scottsdale too!!!

John J. Corey, MD
Phoenix Plastic Surgeon
4.7 out of 5 stars 48 reviews

Bottoming out

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Bottoming out of an implant means that the implants descends low on the chest and below the breast crease. This can give the appearnace of upward pointng nipples in some patients.  If the implant comes out from the nipple incision, that is an extrusion and the implant needs to be removed.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Bottoming Out of Breast Implants

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"Bottoming out" happens when the implant drops below the breast crease. The incision location does not contribute to bottoming out. If adjustments are made to the crease, or if the crease is not well formed, bottoming out may happen.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews


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Thank you for the question.  As the other surgeons have noted, the incision really has nothing to do with bottoming out.  The factors that you should discuss with your surgeon include your starting anatomy, implant size and sometimes implant type.

Peter A. Lennox, MD
Vancouver Plastic Surgeon

Breast implants bottoming out

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Bottoming out occurs when the implants go below the inframammary crease which is nature's best barrier to implant descent inferiorly.  Occasionally, the crease needs to be lowered because of your starting point but this should not be done routinely if possible.  Some patients also have a very vague poorly made natural crease and this increases bottoming out risks.  The incision really has nothing to do with it. 

I advise my patients to wear a custom fit underwire bra for 3 months and in the last 2 years, implant malpositions have been extremely rare.  I also restrict them during that period from activities like running and heavy pec workouts that might also move the implants while they are healing.

Bottoming Out of Breast Implants?

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Thank you for the question.

One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).

Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. This is corrected by “raising” the inframammary fold using internal sutures. This is done after careful measurements are made from the areola to the “new” inframammary fold.

Chances of bottoming out of implants  when placed through an incision under the areola is very small. In my opinion, the chances of implant  malposition are  greater when implants are placed through a “remote” incision line such as the trans-axillary  or trans- umbilical approach.

Of more importance to the success of your operation ( than selection of incision site) is  careful selection of a well experienced board-certified plastic surgeon.

I hope this helps. 

"Bottoming-out" is related to the pocket position, not the incision choice!

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"Bottoming-out" occurs when breast implants end up positioned too low compared to the nipple/areola complex. This can occur when a woman's implant pocket is created too low, regardless of the incision used to make the pocket.

When the implant position is too low related to the nipple/areola complex, the nipple appears too high on the breast mound, but the cause is the same regardless if the patient thinks her nipple(s) are "too high," or her implant(s) "too low." Either the surgical pocket was created too low to start with, or the implants gradually settled there over time, and this "dropping" was not anticipated or planned for.

When both the new crease and the old crease are visible, this is called the "double bubble" deformity, but the cause(s) are similar: implants and breasts don't match in position.

I believe that the axillary incision is associated with a higher percentage of "Bottomed-out" breasts since the arms are raised in order to use this incisional approach, changing the position of the breast on the chest wall, especially when supine as for surgery. After surgery healing, with the patient upright and her arms by her side, the pocket position ends up being too low. (Even a few of these have become centerfold models, though their breasts are far from "normal" in appearance!)

The periareolar incision and inframammary incison each offer similar likelihood for pocket malposition, though some surgeons (myself included) feel that the inframammary incision allows the plastic surgeon to select and secure the proper lower pocket position better than other incisional approaches, as well as to better conceal the visible scars. But we could argue about this all day without objective data to support one point of view or the other.

Your risks are low with any incision; you should first choose the surgeon with the most experience and the best "track record" regarding re-do surgery. Then you can discuss the pros and cons of the various incision choices and any other concerns you may have. Best wishes!


Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 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.