5 Year Old Implants Bottoming Out. What Do You Think? Thank You.

I'm 5'4'', 110 lbs w 300cc submuscular saline implants. Post op, my PS said my nerves were anatomically unusual, & anticipated damage as he created the pocket. I lost feeling & got an infection. 5 years later I'm bottoming out & returned to my PS. He says I'm in the 10% that doesn't scar (to keep the implant in place), but that bottoming out would not progress further. He advised capsulotomy w or w/o lift & implant replacement, or let it be. What do you think of this & what would you advise?

Doctor Answers 14

How to correct bottoming out after breast augmentation.

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Your photographs show marked bottoming out and breast asymmetry. It does not seem like you have breast ptosis, your nipple and areola seem to be at the right location. Because you have very little subcutaneous tissue to support the implant, I would recommend bilateral breast revision with a dermal matrix mesh (Stratice) to support the implants. If you are happy with your implant size, it does not need to be replaced, although a silicone implant might feel more natural.

Breast implants bottoming out

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Bottoming out is a known complication of breast implant surgery, and can be the result of thin tissue, heavy implants, surgical disruption of the normal inframammary folds, or just unpredictable healing.  The standard approach has been to place sutures in the pockets to close off the inferior portions, but some risk of recurrence exists.  A more recent approach is disssecting new pockets, called "neosubpectoral" pockets, closing off the old ones, and placing the same implants back in.  This can work well, particularly if your capsules are not too thin and flimsy.  The use of Strattice (or Alloderm) has been helpful in these cases of bottoming out, but there is a much greater expense for these materials, in the order of an additional cost of $3000-5000 plus just for the material alone.  It is possible that what your surgeon told you and what you are remembering is not exactly the same thing, but if your surgeon did tell you anything about anatomically unusual nerves as a cause of damage during your pocket dissection, or in any way suggested a breast lift (as opposed to lifting the implants), then I would very definitely plan to get a second and even third opinion before embarking on surgical treatment.

Revision breast augmentation is usually successful.

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I don't believe in blaming the patient.  The bottoms of your implant pockets are too low.  They can be raised to an attractive level with a revision, and this usually works.

The repair is done with rows of internal stitches.  Most patients do not need dermal matrix for this.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

5-year-old implants bottoming-out. What do you think?

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Hello! Thank you for your question!  Consideration for either an acellular dermal matrix or mesh-type substitute is reasonable, given your photos and bottoming-out of your implants.  A capsulorrhaphy would be needed for revision of your breast pocket. If you do need such, the use of a dermal matrix or mesh may be considered if your tissue now has significant laxity that is failing in support or a significant deformity in which recreation of the breast pocket is required along with adding additional support and coverage of the implant.  Certainly, the larger the implant, the heavier the weight...thus, it may be useful to consider placement of a matrix or mesh. Otherwise, capsulorrhaphy for pocket revision using your native tissue should suffice.  It has been used safely and effectively to correct synmastia, restore the inframammary fold, support implants as a sling, mask implant issues (e.g., rippling, wrinkling, etc.), and improve aesthetic results in revisionary breast implant and reconstructive procedures.  However, only by physical examination would one be able to make recommendations on the benefits over the risk of using a matrix or mesh in your situation. 

Consult with a plastic surgeon well-versed in breast procedures and the use of dermal matrices and mesh in breast procedures who will assist you in determining which procedure(s) would be the best for you.

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Treatment of Bottoming Out of Breast Implants?

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Thank you for the question and pictures.

It is clear that your implants are positioned too low on the chest wall.

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.

Please make sure your plastic surgeon has ( and can demonstrate) significant experience improving breast implant malposition problems.

Best wishes.

Breast Implants and Bottoming Out

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I agree with you and the other posts:  It appears that you do have bottoming out, with the right breast more affected than the left.  If your appearance is bothersome to you, you may consider a revision or secondary surgery.  This did not occur because of anything you did wrong, nor could you have prevented it.

Bottoming out occurs for several reasons:

1.  Over-dissection of the breast implant pocket

2.  Placement of very large breast implants

3.  Poor tissue quality and strength

There are several ways to correct bottoming out:

1.  Capsulloraphy (i.e. Suturing the sides and lower half of the implant pocket to raise the implant back into correct position behind the implant)

2.  Placement of an acellular dermal matrix sling (to support the breast implant and keep it in a new, higher position)

From your pictures it does not appear that you would need a breast lift along with correction of the bottoming out to fix your problem.  Additionally, if your implant is intact and you are happy with it, you may not need a new implant placed but may be able to use the old one.  However, as you appear thin, a new, silicone implant may feel more natural if choose to replace your breast implants.

I recommend you see your plastic surgeon and perhaps consider a second opinion by a plastic surgeon board certified by the American Board of Plastic Surgery.

Jaime Perez, M.D.

Breast Implant Specialist in Tampa, Florida

Plastic Surgery Center of Tampa, Florida




Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 81 reviews

Breast Implants - Bottomed Out - Sutures or ADM (Acellular Dermal Matrix)

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Hi M198 in Massachusetts

I agree that it looks like you've bottomed out.  There are many different explanations for this but none of them really matter at this point - the main thing is figuring out what can be done to improve the appearance of your breasts.

The first issue is, of course, to raise your implants.  But the main issue is how to maintain them in that elevated position.  Traditionally, that has been done by inserting a series of permanent or long-lasting sutures across the bottom and sides of the pockets (the spaces the implants are in) that will narrow the dimensions of the pockets.  That can work well but it assumes that you have enough tissue to sew together, and that the resewn tissues will then be strong enough to support the implant.

A newer process involves the inclusion of acellular dermal matrix (ADM) such as Strattice or Alloderm into the space.  This extra tissue provides a stronger support for the implant than relying on the sutures alone.

Nothing is perfect, of course.  This is a more involved procedure than just the sutures; it's more expensive, and requires expertise that not every surgeon may have.

But it also may be the way to go.

You should, of course, talk to a few different plastic surgeons to get their opinions including, obviously, those who can see you in person.

I hope that this helps, and good luck,

Dr. E

Breast implant revision

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Yes it appears that you have bottomed out.  The traditional treatment for this has been to do internal capsular suture to shorten the lower portion of your breasts. For complex patients or those that have failed other therapies I usually suggest reinforcing the lower breast with Strattice which dramatically has decreased the recurrence rates of bottoming out in my practice.

Bottoming Out of Implants

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I agree from your photos that your implants are bottoming out.  I d not think that this has any relation to your nerves being "anatomically unusual".  I agree that you should seek  a second opinion.  You may need to have AlloDerm or some other ACD placed to correct your problem, but you should discuss this with your original and a second opinion surgeon.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Get a second opinion

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Looking at your pictures and reading your story, i agree w the other postings here. I would add that i would suggest seeing another plastic surgeon (board certified plastic surgeon). Sincerely, Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 521 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.