What exactly is bottoming out and how can women prevent it? I hear saline has more of a chance of bottoming out. Is this true?

Is it true that once you have a breast augmentation that you will always have to wear a bra to bed for the rest of your life? Does bottoming out mean the breast pocket was too big for the actual implant?

Doctor Answers 10

Bottoming out

Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.

Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Bottoming out can be caused by 2 things

Yes, as mentioned before, most "bottoming out" comes from the surgeon inadvertently (or sometimes intentionally) making the pocket below the fold under the breast.  Does it happen more with saline implant? -- maybe.  Saline implants do this thing called "pistoning" where the fluid is constantly shifting up and down in people doing high-impact type exercises (a lot of bouncing).  That may make an implant stretch out the lower part of the breast.  The safest bet? -- use smaller implants and personally, I prefer silicone gel.  The "Ideal Implant" is a saline option that may reduce the risk as well, but it's too early to tell.

Robert S. Houser, DO
Columbus Plastic Surgeon
5.0 out of 5 stars 15 reviews

What exactly is bottoming out and how can women prevent it? I hear saline has more of a chance of bottoming out. Is this true?

Firstly, saline does not have a greater chance of bottoming out then other types of breast implants. Sleeping on your stomach will decrease your chances of bottoming out. Also, wearing a bra to bed and avoiding downward pressure on the breasts such as bench pressing exercises or too many push ups, etc. 

Richard Zienowicz, MD
Providence Plastic Surgeon
4.9 out of 5 stars 58 reviews

Bottoming out

No, my patients do not wear bras to bed long term. Bottoming out can happen for several reasons, one is the pocket is over dissected, another is that the implant is too big for the breast "foundation", and three the tissues are weak and the heavy implant descends below the fold.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Bottoming out

Thanks for your question. Overdissection inferiorly along the crease (inframammary fold) can lead to a weakening that won't support the implant. Think of a shelf that the implant sits on that bows downward. Things that can increase this happening are large implants that are too wide for the base diameter and a constricted lower pole that has a short nipple to crease distance. In the latter case I use a textured shaped implant to try and allow the fold to be adjusted while minimizing the risk of bottoming out. Yes saline implants are worse. Best of Luck!

M. Scott Haydon, MD
Austin Plastic Surgeon
4.8 out of 5 stars 90 reviews

What exactly is bottoming out and how can women prevent it? I hear saline has more of a chance of bottoming out. Is this true?

Bottoming out is due to the surgical technique creating the breast implant pocket too low. The risk is technique dependent and is not related to the type of implant-saline or silicone.

It should not be necessary to wear a bra to bed after breast augmentation.

The most important thing is to choose an experienced surgeon and a reasonably sized breast implant (usually 350cc or less).

Bottoming out

Hello, bottoming out is when the implant drops below the crease (inframammary fold) under the breast.  This can happen during surgery,for example if a pocket is made too low, or afterward.  There are a number of factors that will increase the risk of bottoming out, such as very large implants, the person's breast tissue thickness and elasticity, their activities, etc.

William Andrade, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 63 reviews

What exactly is bottoming out and how can women prevent it? I hear saline has more of a chance of bottoming out. Is this true?

Thank you for the question.  
Generally speaking, one of the most common complications after breast augmentation surgery is implant malposition. 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 (not necessarily greater with saline then silicone gel breast 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 ( capsulorraphy). Sometimes, depending on the situation, patients benefit from the use of additional support materials such as acellular dermal matrix or biosynthetic mesh.

I hope this, and the attached link (dedicated to breast augmentation revisionary surgery concerns) helps.  Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Bottoming out of a breast implant

Thank you for the question.

Typically, bottoming out refers to the situation where the breast implant falls below the natural or surgically created inframammary fold (the crease or fold line under your breasts where the breasts meet the chest).  If this happens in the early postoperative phase, it may be a technical error from surgery.  In that scenario, the lower support of the breast was violated at the time of surgery to allow the implant to fall lower.  This may also happen much later as time and gravity weaken the lower support of the implant.  There is not necessarily a link between bottoming out whether the implant is saline vs silicone assuming you're talking about equal volumes.  Whatever the cause of bottoming out, if the patient wishes, this can be corrected with a surgery addressing the capsule.
As for your question about wearing a bra to bed, no you will not have to wear a bra to bed for the rest of your life.  I have my patients wear support bras (now-wire) for a period of several weeks after surgery.  Beyond that there are no surgeon-specific restrictions or guidelines.

Hope this helps!

Charles Galanis, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 20 reviews

Bottoming out

In my experience of over 25 years, bottoming out seems to always be related to a larger implant base with than that of the starting point of the natural breast. When one obliterates the natural inframammary crease there is really nothing to hold the implant up. I've never told any patient of mine that they would need to wear a bra even to sleep for the rest of their life. You can make a pocket in the total submuscular plane in which the implant would probably never descend. Unfortunately, the breast which is sitting over the muscle that the implant is under, can still descend leading to a Snoopy type deformity. I recommend you seek the counsel of a board-certified plastic surgeon who can elucidate and extrapolate on these thoughts. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 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.