Bottoming Out

Bottoming Out

What is bottoming out

With bottoming out, the breast implant moves too far down the chest, forcing the bottom crease of the breast to appear lower on the chest. It appears as though the bottom of the breast has dropped so that the bulk of the breast is located too low down on the chest. Clearly, this condition will cause the breasts to feel unnatural; their outward appearance will be abnormal too.

Likely causes of the condition include:

  • Over sizing of the implant pocket
    The surgeon has created a pocket which is too large for the implant. When this is the cause, bottoming out usually occurs within weeks or months of breast augmentation surgery.

  • The breast tissue and skin cannot support the implant
    The skin and tissue are unable to provide enough physical support to hold the weight of the implant in place. In this scenario, bottoming out will typically occur over a longer period of time. This may be also caused with natural attrition of breast tissue with age. If little natural breast tissue is going to offer little support, typically because not much is present, then perhaps unders should be considered.

  • Incorrect choice of breast implant placement
    Complete submuscular implant placement (full unders) results in a much lower risk of bottoming out than with subglandular (overs). With unders, the breast implant is positioned in a pocket of muscle tissue and so it is firmly supported; with overs, the implant is supported only with fatty breast tissue and skin.

How Is Bottoming Out Corrected?

Revisional surgery is required in order to rectify this condition.

  • If the breast implants were originally positioned using the more common subglandular placement (overs), then a submuscular placement (unders) may be used to rectify bottoming out.

  • If the breast tissue and skin is not firm enough to support the weight of the current implant, then a smaller implant may be needed instead. Alternatively it may be temporarily removed while the breast tissue heals and firms. However, a further operation will then be required.

  • If neither of the above solutions are taken, corrective surgery usually involves the surgeon pushing up the implants into their desired position and suturing the bottom of the implant pockets to make them the correct size.