Wanting to Go Bigger, How Do I Avoid Bottoming Out? (photo)

I'm a 5'0 96lb Asian. I am currently 8 weeks post-op and have 350cc round high profile partial unders inside me. I was told last week by my doctor that I have bottomed out. I do wish to go up to 450cc when I have my revision but I'm worried I might bottom out again. What should my surgeon do to avoid this? And what should I do as well? Should I wear an underwired bra right after my revision? My incision will be under the crease again.

Doctor Answers 12

Repairing a bottomed out breast and going larger is a bad idea

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When you have bottomed out, you are already in a tough situation.  There are no absolute guarantees that a fix will last especially if you try to put in a bigger and heavier implant which increases the risk of recurrence.  Also, based on your photo it looks like you are already maxed out in terms of the width HP implant you can handle. You need to be realistic here and understand that you can't always get what you want.

Prevent Bottoming Out after Revision Breast Surgery?

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Thank you for the question and pictures.

Generally speaking, breast implant bottoming out is corrected using internal suture  “repair” of the breast implant pockets ( capsulorraphy).  It may, or may not,  be possible  to go “larger” depending on each patient's specific situation. In some cases, there may not be enough room in the breast implant pocket ( especially after the capsulorraphy) to accommodate a larger breast implant volume safely.

Make sure that your plastic surgeon has significant experience with this type of revisionary breast surgery.  Do not “push” him/her to go with larger breast implants if doing so will increase the risks of recurrence of the breast implant bottoming out.

Your plastic surgeon will have practice specific  supportive dressings/supportive bra etc. for you after surgery.

 I hope this, and the attached link, help.

Revisionary Surgery Complicated

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Thank you for your question and photots.  Unfortunately you already have bottoming out with 350 cc implants.  Larger implants will only increase the risk of recurrence.  You would be better served by a capsulorraphy with the same or a smaller sized implant.  Best wishes! 

George Bitar, MD
Fairfax Plastic Surgeon
4.6 out of 5 stars 59 reviews

Wanting to Go Bigger, How Do I Avoid Bottoming Out?

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Revision of the infra mammary area with ACD matrixes and capsularraphy is my recommendation. As to size 500 UHP cc my choice. 

Implants and Bottoming Out

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  • At 8 weeks post-op and based on your pictures, I don't think it is a certainity that you have "bottomed out".
  • However, with your petite body frame, reaugmentation with larger implants will increase the chance of bottoming out (or make it worse).
  • In my opinion, you should allow settling for at least another 6 months before deciding on reaugmentation.
  • Risks of bottoming out are minimized by limiting implant size and careful surgical dissection in the breast crease area.
  • Crease support (tight bra) may be helpful in some cases but is not a sure preventive for bottoming out.

Thanks for your question and good luck!

Stephen M. Lazarus, MD
Knoxville Plastic Surgeon

Bottoming out and larger implants?

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Usually with bottoming out repairs, smaller implants are a better option. Going larger may push on the repair.  

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

Implant bottoming out repairs need to be carefully done

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I think the state-of-the-art operating for bottomed out implants would include reconstructing the infra-mammary fold with Strattice ADM and using a SMALLER implant. Going larger is at cross-purposes with fixing your disrupted infra-mammary fold. You might consider seeking out a couple of additional opinions from surgeons in your area.

Bottoming out following breast augmentation

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Thanks for your question.  Adding more weight (larger implants) will only place you at a higher risk of bottoming out further if nothing else is done.  The inframammary fold needs to be re-enforced.  This can be done in a number of ways from the use of external to internal sutures.  You will have to speak to your surgeon to find out what is best for your particular set of circumstances.

Shaun Parson, MD
Phoenix Plastic Surgeon
4.8 out of 5 stars 47 reviews

A breast implant revision is necessary to correct your bottoming out of your implants

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Thank you for your question. Bottoming out have breast implants is corrected by repairing or suturing the bottom of your breast implant pocket to reestablish your inframammary crease the normal fold beneath your breast.

Be aware that the most common cause of bottoming out is the need to make a large breast implant pocket to accommodate an implant which is too large for your chest size. Be sure to discuss with your plastic surgeon whether attempting to place 460 50 cc implants will require a larger pocket and risk bottoming out again.

Bottoming out and Repair

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  In general, the pocket will be made smaller and the implant size should not be increased.  The implant should not compromise the repair.  Once healing is complete, you may contemplate a larger implant at a later date.  Underwire bra should not be worn after breast augmentation with an IMF incision.

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.