Breast Implants Bottoming Out? 9 Steps to Reduce The Risks

best breast surgery options for augmentation

9 Steps Can Help Reduce the Risks of Your Breast Implants ‘Bottoming Out’?

Preventing Breast Implants from ‘bottoming out’ in women who have breast tissue laxity & high breast fat, such as in women who have lost significant weight or who have breastfed multiple children.

Bottoming out is a risk for breast augmentation surgery, and especially in people with significant skin laxity.  Everyone wants to know how to avoid it.

Whilst some issues that lead to bottoming out can be beyond the control of you or your Surgeon, here are 9 steps to prevent your implants from sinking down and ‘bottoming out’.



First, some definitions.

What is ‘bottoming out’ and what causes it?

Whenever you have implants (breast augmentation), you need to be patient for some time to allow the breast tissue to distribute itself around the implant and for a natural shape to evolve.

However, when an implant loses its internal support – when your skin is not able to hold the implant properly in place – it can begin to sink towards the lower part of the breast area. This is known as ‘bottoming out’.

If you experience bottoming out, you will notice the following:

  • The distance between your nipple and your infra-mammary fold (IMF), e.g. where your bra underwire sits, gets stretched out.
  • The bottom of your breast tissue seems to bulge slightly downward.
  • Sometimes bottoming out makes your nipples appear as if they are pointing more upwards than forwards.
  • Sagging, is when the skin ages, stretches and sags and your nipples point more south than forward.

‘Bottoming out’ with implants largely occurs because of breast tissue laxity (loss of skin elasticity).

A healthy breast has natural supportive ligaments, but some women with tissue laxity, such as post-weight loss patients with excess skin, often don’t have sufficient skin strength to support their chosen implant.

That’s a good reason to choose smaller to moderate sized implants when you’re having augmentation procedures performed!


bottoming out - best breast implant surgery options for augmentation

This loss of skin elasticity linked to bottoming out can result from:

  • Dramatic weight loss such as after Gastric Banding surgeries to combat obesity
  • Pregnancy or Breast-feeding and other hormonal changes impacting the breast tissues
  • A high concentration of breast fat
  • Certain medications or medical treatments (including ones you’ve had in the past)

When ‘bottoming out’ occurs, there is often little that can be done to remedy it other than Corrective Surgery involving a Breast Lift procedure (a Mastopexy or Breast Lift surgery).

  • Corrective Surgery for bottoming out is sometimes a two or three step process.
  • Sometimes your breast implants will need to be removed, and your breast pockets given time to heal.
  • Once new breast implants are re-inserted, added precautions are likely to be needed, to help support the weight of the implant.
  • Sometimes an implant size adjustment might help reduce risks, but if you have very loose or low skin collagen (lost elasticity), you may need to evaluate your other options (potentially Motiva or Mentor implants) or choosing smaller implants.

Preventing bottoming out after Breast Augmentation

If you’re considering breast implants, one of your primary aims is to avoid the need for Revisional Surgery, as much as possible.

So it is best to aim to PREVENT bottoming out from occurring, rather than resorting to a revision surgery due to skin laxity problems or concerns with trying to go too large with your breast augmentation options.

That’s why it’s very important that you do your breast augmentation research, choose your Surgeon carefully, and ask the right questions.

If you want to try to minimise the risks of bottoming out, consider these potential STEPS when planning for your breast augmentation. At the very least, your Surgeon will likely be impressed by your knowledge and preparation.



9 Ways to Aim to Stay on Top of risks of your Breast Implants ‘bottoming-out’

How to prevent ‘bottoming out’ with implants: Tips & Suggestions

STEP 1:  It may sound obvious, but the most important measure for a good outcome is for your SURGEON to get it right the first time – but your choices also have an impact here, as you may inadvertently insist on an implant size that is too large for your existing skin condition.

But your choice of Surgeon IS important.  Even good Surgeons can have patients that have bottoming out, as skin – and ageing of your skin – can be somewhat unpredictable. So, too, can unexpected lifestyle changes (such as smoking, pregnancy or breast feeding a baby).

So step 2 means doing your homework and choosing the right Specialist Surgeon for your Breast Augmentation. And it means making the best implant choices you can, in relation to your physique, your augmentation goals AND your skin condition.



  • Remember that skill levels, as well as pre-surgery markups and precision and artistry, differ markedly amongst Surgeons.
  • Don’t be afraid to look at a Surgeon’s CV and choose someone who has SPECIALISED in Breasts (they should be FRACS, ASPS, ASAPS & ISAPS members).  Cosmetic Surgeons may NOT actually be genuine Plastic Surgeons – it pays to investigate whether or not they have FRACS and can actually operate in a proper hospital facility (versus just a back room).
  • If you have had PRE-EXISTING Breast Surgery, you may require a more complex procedure AND you may still NOT get the results you want as some things can’t be fixed and pre-existing surgery will leave some scar tissue or other concerns for your Surgeon to accommodate.
  • Do you have ‘drapey’ skin that is somewhat lax? Yet another reason to select a Specialist Plastic Surgeon who is highly skilled in breast augmentation procedures (we have highly experienced Specialist Plastic Surgeons on our team at our Clinics).
  • Ask your Surgeon what complications they’ve had, what they learned from it and how they handled it.
  • Avoid a Surgeon who dismisses or does not discuss potential complications) as ALL Surgeons can have these – it’s just a matter of complication frequency, prevention measures and how they handle them.
  • Your Surgeon should be able to tell you the pros and cons of different implant.

breast reduction, beautiful results plastic surgery breasts

STEP 2: Know your own body – you’ll be aware of any dramatic weight loss or the effect of breast-feeding on your breast tissue.

  • If you have stretch marks or other signs of skin laxity of the breast tissue, and your Surgeon doesn’t mention taking any precautions against ‘bottoming out’, please make certain you raise this risk yourself.
  • Then have a conversation about the various options available to aim to prevent this from occurring.
  • The preventative measures may or may not work; but it’s worth thinking ahead if you know you have a fair amount of laxity in your skin.
  • If you know you have skin laxity or sagging breasts, and your Surgeon doesn’t mention your skin as having an impact on your surgery; ask a Plastic Surgeon for a second opinion. Because a good Surgeon knows that your skin WILL impact your results.
  • Decide if you want the risk of bottoming out (many people want breast implants, so they take this risk, but you and your Surgeon should at least aim to prevent the bottoming out if possible).


sub-muscular placement


STEP 3:  There are variations available for the Breast Augmentation procedure. Some of these variations can have an impact on the appeal and longevity of your surgery results. Your Surgeon will be able to recommend what your best options are for your implant/breast augmentation procedure.

  • Having sub-muscular implant placement may reduce the risks of bottoming out.
  • Also, if your breasts implants are placed completely under the muscle (the pectoralis muscle), the risks of bottoming out may be reduced, but this may not be the best approach to augmentation.
  • If a trans-axillary incision (an armpit incision) is made, this doesn’t form a cut on the bottom of the breast tissues (the breast crease or breast fold), so for some patients, this may also help reduce the risk of ‘bottoming out’.
  • Your Surgeon will be able to explain how each of these procedures differs – as there are PROS and CONS involved with breast implant placement options; also, trans-axillary incisions may have other risks you might want to avoid; and it can only be performed on the primary augmentation (not a removal and replacement augmentation).



STEP 4: Be wary of using exceptionally large implants if your breast tissue is thin or has laxity.

  • Sometimes using very large implants on a small frame puts unnecessary pressure on the supporting breast tissue.
  • Large implants with lax skin is also a concern and can lead to higher risks of bottoming out.
  • It is best to get an implant that is proportionate, small to moderate in size; but not excessive in size or weight.
  • Your breast implants should also be an appropriate size and shape for your body.
  • Your Surgeon should take into consideration your existing breast tissue (skin) and existing breast fat (internal fat ratios and distribution).
  • Your surgeon should give you practical Aesthetic advice about the short and long term effects of choosing very large implants if you have a small body, so consider this input seriously even if you see other breast implant trends in your social circle.
  • Choose what’s good for YOUR body, your pre-existing breast tissues and the laxity of your skin, not based upon what other’s are doing.

breast implant surgery for breast enlargement


STEP 5: Patients have reported higher satisfaction rates with Silicone implants; these implants are often less dense than saline implants so may potentially be less likely to lead to ‘bottoming out’.

It makes sense that denser breast implants may succumb to gravity more than less dense implants, so it may be that lighter or smaller implants – or ones that are very well suited to your body and placed appropriately – will have less chance of ‘bottoming out.’

Also, a recent study found higher satisfaction rates with SILICONE over SALINE implants.

STEP 6: Follow all post-op instructions to the letter after your Breast Augmentation Surgery

  • Don’t rush back into your exercise routine or to high impact activities  – follow the guidelines and check with your Surgeon
  • Make sure you wear the right supportive garments and bras following a breast augmentation, so that the breast tissue is aided as it adjusts to the new weight it’s supporting and over time when you’re participating in sports (the right post-op garments & good sports bras are essential).
  • Keep wearing a bra 24/7 that adequately supports your new breasts.

Wearing a bra applies particularly when larger implants have been used and have been placed on top of the pectoralis muscles.

  • There’s still no guarantee especially if you have lax skin or a lot of breast fat, but prevention can go a long way
  • Be warned, however, that NO bra will be able to support breast tissue if the procedure hasn’t been properly done.


STEP 7:  Ask about the potential for cellular dermal matrices for your body or other placement techniques that can help prevent ‘bottoming out.’

  • There are several types of potential dermal matrices that have proven useful in breast reconstructive surgery.
  • In essence, this is a type of cushioning fabric that will provide additional support for implants.
  • These products act like an internal bra or scaffold to help support the weight of a breast implant.
  • They tend, however, to be extremely expensive and can add to the costs of surgery.

STEP 8:  Ask about your potential for Anchoring Structures

  • Skin assessments, best implant placement choices and pre-surgery measurements are key skill sets of great Breast Augmentation Surgeons.
  • Pocket size and implant pocket shapes are also key influences to outcome; as is assessing your skin’s laxity or other issues that may contribute to bottoming out.
  • At the end of the procedure after your implants have been positioned, anchoring sutures can sometimes be placed to secure the deep connective tissue of your breast to the connective tissues of your chest wall.
  • This creates a temporary barrier as the implant is healing and may help reduce the likelihood of the implant settling downwards.
  • If you’ve already had surgery and have had some bottoming out of your breast implants, ask about these options and about the steps to corrective surgery.

STEP 9:  A more technical issue relates to ‘capsular adherence’ and textures of the implant.

  • There are some breast implants that have a higher degree of adherence to internal tissues due to the texture or format of the breast implant shell.
  • This means that the capsule your body forms around the breast implant may adhere to its surface more, which might help hold it in position if your skin is lax. However, there are pros and cons to different textured breast implants and research is ongoing (Ask your Surgeon during a consultation).
  • Different Plastic Surgeons also have different views, professionally, as to the effectiveness of different textured breast implants, coatings and placement options.
  • Research continues to explore if some textures are better in terms of preventing bottoming out; but typically, it depends on your skin as well as your breast implant size choice, and your weight changes, hormonal balances, age and lifestyle will also have an impact.
  • Discuss the type of implant and the surface of the implant with your Surgeon before consenting to surgery (and to reconstructive surgery or a breast lift with augmentation, as a Breast Lift with Implants means you already have skin laxity and sagging, which means your bottoming out risks are higher).

Ultimately, every patient’s situation is a little different but the one thing no one wants is a further surgery to correct the first one.

You can hope for the best, or can adopt a realistic, informed approach to your breast augmentation. We recommend you take every precaution to get an excellent result. You can also ready our TIPS forgetting the best long-term results from your breast surgery.

Unsure about the Plastic Surgery and procedure best for you?

Our Specialist Plastic Surgeons located in Melbourne will be able to assess your desired goals and suggest the best options for your Breast Implant surgery.

Please contact a Patient Care Team at Cosmetic Surgery for Women & Men today to book your consultation.

Phone (03) 8849 1444 or Email us at:

If you liked this article on bottoming out, you may also enjoy reading:

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How to avoid Breast Augmentation risks like ‘bottoming out‘ and ‘rippling’?


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Dr Geoff Barnett - MBBS, FRACS (Plast)
Dr Geoffrey Barnett, FRACS (Plas) is a Melbourne based Specialist Plastic Surgeon who has over 35 years of expertise in Plastic & Reconstructive Surgeon for Cosmetic Surgery, Plastic Surgery and Body Contouring Surgery after Bariatric Surgery.Qualifications and Memberships: Specialist Plastic Surgeon (FRACS) Member - Fellowship of the Royal Australasian College of Surgeons in Plastic and Reconstructive Surgery [FRACS (Plast).The Royal Australasian College of Surgeons (RACS) is the only professional body recognised by the Australian Medical Council (AMC) and the Medical Council of New Zealand (MCNZ) to train Surgeons in Australia and New Zealand.Author BIO page: