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Bottoming Out

September 18, 2020

What is it

“Bottoming Out” is an expression when your breast implants after breast augmentation surgery are too low. Your breasts have too much volume at the bottom of your breasts, and your breast fold may appear too low in relation to the rest of your breasts.

How does it happen

During breast augmentation, the pocket for your breast implant is created. If the pocket is created properly, sometimes your breast tissue at the bottom of your breast near the breast fold may be a little weak, and over time, your breast implants may become a little too low compared to the rest of your torso.

If the breast implant pocket is over-dissected and made too low or too large, then your breast implant may migrate down your rib cage.

During surgery, it’s important to close the breast fold incision quite well. This may require reinforced barbed suture, using a “cuff” of normal internal fascia as a sling to hold the lower portion of the breast implant, or both to ensure the breast fold and lower part of your breast remains stable over time. Some plastic surgeons refer to this as an “internal bra” to support your breasts.

How to prevent it

Essentially, it’s important to make sure that you follow post-care instructions after your breast augmentation, and make sure to NOT massage your new breasts forcefully downwards. Wearing the proper bra after breast augmentation may also help to prevent bottoming out as well.

How to correct it

Bottoming out can be corrected by reinforcing the breast fold and ensuring that your breast implants are in the proper position. There are 2 common ways to do this:

The first way is to go back in, remove the breast implant, and use the scar tissue around the breast implant, aka the “capsule,” to reinforce the bottom of the breast implant pocket. The plastic surgery term is called a “capsulorrhaphy.” The capsule can be cut, or folded upon itself, or both, and a new breast implant fold is created that is placed at the appropriate height.

A second way is to create a new, higher breast fold using strong reinforced material. Commonly you can use Acellular Dermal Matrix (ADM), which is tissue derived from humans or pigs. Another common material is Poly-4-Hydroxybutyrate (P4HB).

ADM commonly comes in sheets, and can be cut and sutured in customized fashion to support the lower portion of your breast fold. P4HB comes in sheets or in pre-formed curved support, and can also be customized and placed to strongly reinforce the breast fold.

All of the above methods are sometimes called an “internal bra” as well, just to confuse all patients and even plastic surgeons as to what is being done! Make sure to talk to your plastic surgeon about the very specific substances and details about your specific procedure.

Both procedures are done in the operating room, and usually done within a couple of hours. Both procedures generally require a breast fold incision, so if you already have one the same incision can be used to gain access to the breast fold area. If you do not have this incision, your plastic surgeon will probably recommend one to give you the best matching symmetric and aesthetic results.

Recovery is typically pretty fast, since they are not that painful for most patients.


Bottoming out is a total bummer! However, the good news is that it can usually be corrected in a single outpatient procedure. The results last a very long time, and will change only due to significant weight loss or gain, decades of aging, or other reasons. Once your breast fold is fixated and corrected to the proper position, your bottoming out should not come back for years or decades.

If you would like a consultation or have any questions, please call/text me at (415) 362-1846 or email me at .

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