Have I bottomed out? (Photo)

375 cc under muscle high profile silicone implants with incision on fold. I am 105 lbs 5'4 and so worried I've bottomed out!!! Plz help scars are high and uneven and nipples are also high to me. Am I being paranoid or will I havet to pay for another surgery I'm so worry. 7 mnths post o.p

Doctor Answers 10

Bottoming Out?

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Your photos suggest that your implants are low relative to your nipple position.  While this is often referred to as bottoming out an important distinction should be made between bottoming out and fold malposition.  When used accurately the term "bottoming out"  refers to stretching of the skin between the nipple and the fold.  On the other hand, the term "fold malposition"  refers to the crease beneath the breast falling to a lower position.  Assuming your incisions were placed within the fold (or the intended new fold) then the fact that they have appeared to rise up onto the breast implies the fold has given way and the implant has fallen beneath it resulting in fold malposition.  (It could also be true that bottoming out has occurred with stretching of the skin between the nipple and the fold.)  The distinction is important because the treatment may vary depending on the proper diagnosis.

Saint Louis Plastic Surgeon
5.0 out of 5 stars 81 reviews

Have my breast implants bottomed out?

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Thank you for your question.  Your nipple position is high and there is more breast implant below the nipple areola than above.  This does indicate bottoming out.  Please see your plastic surgeon as a revision is possible..

Have I bottomed out?

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Thank you for your question. Based on your pictures it does seem that your implants have bottomed out. This will need to be corrected with surgery with placement of internal sutures to repared the breast capsule. Be sure to see  a certified Surgeon with experience in Revisional breast surgery. 

Franco R. Jacome, MD
Mexico Plastic Surgeon
5.0 out of 5 stars 8 reviews

You have bottomed out

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You are correct in your self diagnosis.  You have bottomed out.  This also explains your issues with your nipples positioning. It will take another surgery to correct these issues.  

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 24 reviews

Bottoming Out After Breast Augmentation

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Yes and this is a known potential risk of breast implant surgery. It's not uncommon for implants to descend over the course of the first 3 months postop. It appears yours have moved lower than desired...more common after submuscular placement with release of the fold to allow your breast pocket to accommodate your larger implants. Fold reinforcements, pocket changes, and mesh are all options to get your implants into a more appropriate position on your chest wall. Best of luck.

Have I bottomed out?

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I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are  appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”).

It is possible that you are feeling the implants significantly along the lower poles of the breasts. Patients in your situation often complain of discomfort in the area of implant malposition. Also,  consistent with the breast implant positioning problem, the nipple areola complexes seem to be sitting relatively high, because the breast implants have settled too low.  Furthermore, the inframammary fold scars sit too high on the breast mounds secondary to the breast implants' displacement.  

I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair).  This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly.  Associated issues with positioning of nipple/areola complexes and visibility of the inframmammary fold scars should improve with this operation.

Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery.  

I hope this, and the attached link, helps.

Bottoming out

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Thanks for the great question and the photos. It does appear as though your implants have bottomed out. This can be due to a variety of reasons. The best way to fix it is to have revision breast surgery by an experienced surgeon. When the implants are repositioned into an appropriate location, you nipples will appear to be in a more nature position on your chest wall. I'm sorry you're going through this and best of luck.

~Dr. Sieber

David A. Sieber, MD
San Francisco General Surgeon
5.0 out of 5 stars 40 reviews

Bottoming out after BA

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It appears you have bottomed out .  This causes the nipples to appear too high and , in some patients, causes discomfort in a bra.  Although some have written about correction without surgery, I believe you will need surgery to correct it.  Make sure the surgeon of your choice can show you before and afters of such corrections. It is a difficult problem and you need someone experienced. Best wishes. Below is an example of such a correction.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

Bottoming out - please follow-up with your surgeon

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From your pictures, it does look like you are experiencing bottoming out.

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.

Clinical signs:

·         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 to be wearing supportive bras as this prevent further bottoming out. Supportive bras will apply 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. 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 517 reviews

Bottoming Out after Breast Augmentation #breastaugmentation

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  • Your photos demonstrate bottoming out of your implants.  
  • The implants have dropped down below your infra-mammary fold.  This causes your nipples to appear much too high on your breasts.
  • To correct this, you will need a revision of your breast augmentation.
  • Internal sutures will have to be placed into the breast capsule to lift the implants up to the correct position. 
  • Thanks for sharing, and so sorry that this has happened to you. 
  • Definitely discuss with your plastic surgeon. 

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.