Bottoming Out of Breast Implants – can it be fixed?

best breast surgery options for augmentation

What does “breast implant bottoming out” mean?

Bottoming out is a condition that may occur after breast implant surgery.  Bottoming out is indicated by the lower portion of your breasts bulging outwards OR appearing out of proportion with your overall breast shape or upper pole area.

If your breast implants have bottomed out:

  • you may notice an IMBALANCE in your post-op breast shape (lower pole seems longer)
  • differences between upper and lower POLES may be more noticeable than typical “teardrop shapes” or rounded breast shapes after surgery
  • NIPPLES may point upwards rather than remaining in a central, forward OR front-facing location

Settling of Breast Implants vs Bottoming Out

Settling of breast implants after Surgery – description

Breast Shapes just after surgery are subjected to changes and time impacts results.  Recognise that breast implant settling is common, and doesn’t mean you’re ‘bottoming out’.

  • Some Breast implants take a few months to ‘settle’ into position in the breast pocket
  • Post-op SWELLING also means your breasts MAY initially LOOK LARGER – and more projected – than they will once you recover.
  • This may lead you to think something’s changed or that your breasts have dropped in size after surgery.
  • This is typically normal due to resolving swelling; but if you have questions or concerns, see your Surgeon.

Settling into position is the REASON some Surgeons place breast implants a bit higher than YOU think is going to look BEST

  • You might feel your UPPER POLE shape is too full – or your breast implants ‘up too high’ AT FIRST
  • But over several months’ time, you’ll discover the implants are settling into a good position on your chest wall, which might help extend the LONGEVITY of your results

Upper Pole Position vs Lower Pole: Breast Shape and Projection Balance

  • GOOD augmentation surgery results RELATE to breast size, breast shape, balance and position.

Limitations to good results from breast implant surgery include your SKIN STRENGTH. If you have elasticity atrophy (weakened internal structures to hold your implants in place), you may be at higher risk of bottoming out.

Key risks for bottoming out of implants include:

  • SKIN: your skin simply can’t handle the size of implant you want AND/OR
  • PTOSIS: you really needed a breast LIFT (Mastopexy) along with implants to address your drooping skin and nipple position
  • POCKET: the shape or size/placement by a less-trained Surgeon

When you choose Breast Implants that are VERY LARGE in size for your skin condition – or placed too low – they can sometimes bottom out.


Bottoming Out – more detailed description

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

  • The distance between your nipple and your infra-mammary fold (IMF or breast crease) appears “stretched”
  • The bottom of your breast tissues seem to bulge slightly downward
  • Your nipple(s) may appear to point more upwards than forward

Proper REVIEW and assessment by your Plastic Surgeon is required (self-assessment is not recommended) as other factors could be impacting your results.

Am I bottoming out? Bottoming Out VS Sagging Breasts

Compare bottoming out (above) to normal breast sagging:

  • Normal SAGGING (skin ptosis) can occur with age and after pregnancy, weight loss and breastfeeding
  • Bottoming OUT can occur when your skin can’t support the breast implant SIZE or position

BOTTOMING OUT is more a shape imbalance than a ptotic issue.

Visual differences:

  • In breasts with skin PTOSIS, breasts SAG or DROOP and look EMPTY
  • They don’t BULGE at the bottom, they SAG
  • Nipples POINT downwards vs UPWARDS

In BOTTOMING OUT, there’s an IMBALANCE of upper/lower pole projection (volume). In sagging, there’s skin drooping and lack of shape rather than an imbalance.

Summary: Bottoming out’ with implants largely occurs when there is breast tissue laxity (loss of skin elasticity) and/or when too large an implant size is chosen; E.g. when a smaller implant size AND/OR breast lift-augmentation may have yielded a more lasting result.

Can Bottoming Out be fixed?

When ‘bottoming out’ occurs, revision Breast Surgery is required.

  • This may involve implant exchanges along with Mastopexy techniques to lift the breasts and nipples.

Corrective Surgery for bottoming out is sometimes a two or three step process.

  • Sometimes your breast implants need to be removed, and breast pockets given time to heal.
  • Then, new breast implants are re-inserted, but added precautions may be needed to help support the weight of the implant.
  • An implant size adjustment MIGHT help reduce future risks of bottoming out; but IF you have very loose or low skin collagen (lost elasticity), you may need to evaluate your other options such as smaller implants or a breast lift with or without breast implants.

9 Steps to Reduce Risks of Your Implants ‘Bottoming Out

 

 

 

 

STEP 1:  Choose a skilled Surgeon

  • Choose an expert in Breast Augmentation and ask about your specific skin condition risks
  • Consider recommendations for moderate to small enlargements or COMBINED breast lift/augmentation procedures

breast reduction, beautiful results plastic surgery breasts

STEP 2: Know your own body

  • Stay aware of dramatic weight loss and the effect of breast-feeding on your breast tissues
  • If you have stretch marks AND other signs of breast skin laxity – and your Surgeon doesn’t mention taking any precautions against ‘bottoming out’ – RAISE this risk question during your consultation
  • Ask about your preferred SIZE and SKIN STRENGTH limitations
  • Not all prevention measures protect against this risk, but you might as well TRY to reduce your risks of bottoming out if possible.

STEP 3:  Discuss and EVALUATE position options with your Surgeon

  • Some surgeons feel that sub-muscular implant placement may reduce the risks of bottoming out for select patients; but every Surgeon has a unique view
  • Plus, if your breasts implants are placed completely under the pectoralis muscle, risks of bottoming out MIGHT be reduced, but this may NOT be the best technique for your appearance goals
  • Ask your Surgeon if a trans-axillary incision (an armpit incision) is an option for you

STEP 4: Be WARY of using exceptionally large implants if you have skin laxity

  • Very large implants on a small frame places unnecessary pressure on your supporting breast tissues.
  • Large implants with LAX skin is linked with higher risks of breast implants bottoming out.
  • Choose an implant that is proportionate, small to moderate in size; and not excessive in size or weight

breast-revision-surgery

 

STEP 5: Check satisfaction rates with Silicone implants

  • silicone implants may be less dense than saline implants and may potentially be less likely to lead to ‘bottoming out’
  • lighter or smaller implants – well chosen and placed appropriately – may help reduce chances of ‘bottoming out’plants.

STEP 6: Follow your post-op instructions

  • Recovery is crucial to successful surgery results – so don’t rush back into your exercise routine or high impact activities too quickly
  • Follow the guidelines and check with your Surgeon
  • Wear the right supportive garments and bras (24/7) as recommended

There’s still no guarantee especially if you have lax skin or a lot of breast fat, but prevention can go a long way

STEP 7:  Review the effectiveness of cellular dermal matrices and other internal bra techniques

  • Some surgeons use dermal matrices for reconstructive surgery – these significantly add to surgery costs
  • Others may use internal bra techniques and special suturing to reduce bottoming out risks

STEP 8:  Anchoring Structures

  • Anchoring sutures may be used by some Surgeons to secure the deep connective tissues of your breast area to the connective tissues of your chest wall
  • This may create a temporary barrier as the implant is healing and may help reduce the likelihood of the implant settling too far downwards

STEP 9:  ‘Capsular adherence’ and textures of the implant need to be assessed

  • Some breast implants may have a higher degree of adherence to internal tissues due to shell texture
  • This could lead to the capsules adhering more, and may help hold implants in position if skin is lax
  • However, there are PROS and CONS to different textured breast implants

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.

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: enquiries@plasticsurgeons.com.au

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Last updated: 13/08/2019
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Dr Geoff Barnett
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: https://plasticsurgeons.com.au/dr-geoff-barnett/