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Patient Details
Correcting Bottomed Out Breast Implants with Smaller Implants and a New Pocket
This patient came to me after a previous breast augmentation performed elsewhere using 325cc silicone implants placed under the muscle. Over time, her implants had bottomed out—a condition where the implants drop too low on the chest, causing the nipples to point upward and the natural breast shape to become distorted.
Why did this happen? Bottoming out is often caused by a combination of factors. In her case, the larger implant size and her active, exercise-focused lifestyle likely contributed. Submuscular implants (placed under the chest muscle) can gradually be pushed downward with repetitive chest movement. Over time, this stretches the skin and weakens the lower support of the breast.
One of the most important things women can do after breast enhancement surgery is to wear a high-quality support bra—especially during workouts and daily activities. Support matters.
My Surgical Approach
To restore her natural shape and prevent future complications, we took a different path for her breast revision surgery:
- We chose smaller 275cc implants to reduce the weight and tension on her tissues.
- I closed off the old submuscular pocket and created a new one above the muscle (subglandular) to avoid distortion from muscle movement.
- This repositioning also allowed me to place the implants in a more anatomically ideal location, helping the nipples face forward rather than upward.
As you’ll see in her before-and-after photos, her implants now sit higher and more naturally on the chest. The inframammary scars from her previous surgery are now well-hidden within the newly created breast crease.
Why Implant Size and Placement Matter
Too often, patients are given implants that are simply too large for their anatomy, increasing the risk of bottoming out and other complications. Bigger isn’t always better. Smaller implants often yield more natural results and carry fewer long-term risks.
There are trade-offs between placing implants above vs. below the muscle, and every case is unique. In her case, I believed a subglandular placement would offer more stability and better long-term outcomes.
Supporting the Repair
The most common complication after bottoming out repair is recurrence. In some patients, I may need to use internal support materials like biologic or synthetic mesh to reinforce the repair. However, these materials add cost and carry their own risks, so I prefer to avoid them when possible—experience helps me make that judgment.
Regardless of technique, one thing remains true: long-term success requires excellent support. A proper bra that lifts the breasts “up and in” is essential for maintaining the results of surgery.
