Bottoming Out

Bottoming out is a condition in which a breast implant moves below the breast crease after surgery. The breast would appear “bottom heavy” and the nipple would be high, along with a loss of superior breast fullness. This causes the breast to appear less youthful, with a long upper chest and breasts that appear to be sitting on the upper abdomen.

Breasts Bottoming Out - Secondary Breast Revision - Breast Complications - Dr. Caridi in Austin, TX

What causes bottoming out? 

If your surgeon makes the breast implant pocket well below the natural breast crease, you are at risk for bottoming out. Large, heavy breast implants may move below the natural crease from pressure in that area. Very large breast implants in a patient with small, high breasts may have no place to fill other than the area below the breast, causing bottoming out.

How do you diagnose bottoming out? 

There is no specific test to diagnose bottoming out. It’s simply the appearance of the breast when the breast implant moves below the breast crease. If your incision is at the breast crease, you may see that the scar rides upward out of the crease and appears on the mid-to-lower part of the face of the breast. This occurs slowly, so some women simply aren’t aware of these changes over time.

What are the symptoms of bottoming out? 

Pain is not associated with bottoming out. You may notice thinning of the skin at the bottom of the breast, which will allow you to more easily feel the breast implant. Your breasts may feel “bottom heavy.”

What can I do to prevent bottoming out? 

Choose the right surgeon and make sure that your implants fit your frame and tissue quality. Wear a supportive underwire bra that applies pressure to the fold at the bottom of the breast.

How is bottoming out treated? 

The best way to treat bottoming out is to reinforce the implant capsule at the bottom of the breast. A procedure would be needed to secure the implant in an elevated position and to fix the new breast crease with a suture technique. There may be a need for Acellular Dermal Matrix, a soft-tissue graft, in the repair. A smaller implant is often advisable, if the original was too large. A supportive bra will maintain optimal breast implant position and breast shape.

Can bottoming out recur? 

If your breast implants are appropriately sized for your body and tissue characteristics, a repair should hold up. If a surgeon only sutures the crease at the bottom of your breast but doesn’t advise you to replace large or heavy breast implants, you are at risk for recurrence.

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