Breast Revision Gallery Plastic Surgery in Austin | Patient 88

Patient Details

Treating Breast Implant Bottoming Out

What is bottoming out?
Bottoming out happens when breast implants slip too low on the chest, below the natural crease (the inframammary fold) where they should sit. When this occurs:

• The nipples appear higher on the breast mound
• The upper breast loses its fullness
• The surgical scar may ride up on the breast and become more visible

This leaves the breast looking unbalanced and unnatural.

How do we fix bottoming out?
Surgery is required to restore proper implant position and improve breast shape. Some key principles include:

1. Choosing the right implant size
   Large implants increase the risk of bottoming out. Selecting implants that are proportional and “normal-sized” for the patient’s body helps prevent recurrence.
2. Reinforcing the breast fold
   During surgery, the lower fold is repaired and tightened so the implant sits correctly. In some cases, I may use supportive material—either synthetic or biologic mesh—to help reinforce the fold and prevent the implant from sliding down again. However, this isn’t always necessary.
3. Post-surgical support
   A key part of long-term success is wearing a supportive bra that keeps the implants lifted and in place. Patients should commit to wearing a “working bra” that provides continuous support, especially in the first year after surgery.

A recent case example
One of my patients came to me with bottoming out from a previous breast augmentation done elsewhere. Fortunately, she didn’t request larger implants, which would have made the problem worse. During her revision surgery, I found that mesh support wasn’t needed. Instead, I carefully repaired the breast fold and placed her existing implants back into the correct position.

Her results looked natural again, with restored fullness and balance. She agreed to wear a supportive bra at all times, which is essential to maintaining her long-term outcome.

Takeaway: Bottoming out can be corrected with the right surgical plan. Proper implant selection, careful fold repair, and patient commitment to postoperative support all play critical roles in achieving a stable, natural result.

Would you like me to also create a before-and-after style infographic you can use to visually explain bottoming out and its repair for your patients? That way you could use it on your website or social media alongside this text