What is “Bottoming Out”?

If you have a breast implant, they can (rarely) appear to slide down or be too low on your torso as you heal.  The plastic surgery term is called “bottoming out.”

Bottoming out occurs when a breast implant moves and settles too low on the patient’s chest wall or rib cage. This causes the nipple-areola complex to appear higher on the implant than it should be, making one breast appear significantly larger. Additionally, bottoming out may cause visible rippling along the bottom portion of the implant as well as a double bubble effect where two distinct mounds are visible instead of one symmetrical shape.

Bottoming out typically occurs due to inadequate support of the lower pole of the implants by either not having enough tissue coverage or an insufficiently strong muscle base that supports them. In some cases, the lower portion of the breast implant pocket is too large at the bottom. In addition, patients with severe weight fluctuations after their procedure may experience bottoming out due to weakened tissues and muscles around their implants.

Fortunately, there are treatments available, including:

• Increased support with sutures or capsule tissue at the base of your breast
• Use of an “internal bra” to strengthen the lower portion of your breasts.
• A switch to slightly lighter weight implants or different profile implants.
• Fat Grafting at the base of the breasts to improve cleavage and appearance.

This is my patient, who was very patient overall, allowed the area to fully heal, and also allowed me to correct the left breast lower pole area.  I used an “internal bra” and a revised pocket to make the breast folds more symmetric and correct the “bottoming out.”

And yes, in general, I have very few complications, but I’m being fully transparent in this case.

There is an old saying in surgery-  if you don’t have any complications as a surgeon, you’re not operating.  I am always thankful for the best patients since they are willing to share their journey of aesthetic improvement with the world!

Comment down your thoughts and questions!