So, what does breast implant bottoming out mean?
The term refers to when the Breast implant drops below the natural crease of the breast, resulting in the lower pole (area below the areola) bulging/bottoming out making the breast seem out of proportion.
Upper pole is the area of the breast above the areola/nipple. Lower pole refers to the area below the areola.
Have your breast implants bottomed out?
- Have you noticed an imbalance?
- Do your Breasts look different than they did post-op?
- Do your upper and lower poles look different?
- Has the location or direction of your nipple changed?
- Do they point upward instead of staying central or front-facing?
Settling of Breast Implants vs Bottoming Out
After surgery, your breasts are subjected to changes, and your breast shape will take time to settle. It’s important to remember that ‘settling’ is normal and does not mean you are ‘bottoming out’. It’s important to remember:
- Those breast implants can take a few months to ‘settle’ into their position.
- Swelling is normal Post-op. Your breasts might initially look larger than you anticipated. The swelling will reduce as you heal and recover.
- The reduction in swelling and ‘settling’ may make you think something’s not right or that your breasts have dropped in size after surgery. However, more often than not this change is just the reduction in swelling
- If you do have questions or concerns about your implants, it is important to, see your surgeon.
Settling is the reason a lot of surgeons will place the breast implant slightly higher than you expect. At first, you may believe your upper pole shape is too full. In other words, the implant is sitting too high. Over time, usually the first several months, you will find that the implants are ‘settling’ into a good position on your chest wall. This can help extend the longevity of your results.
Breast shape and projection balance – Upper pole position vs lower pole
Good augmentation surgery results relate to breast shape, size, balance and position. Some factors can impact your results, including your skin strength. Elasticity atrophy can also increase the risk of you bottoming out.
Risks associated with bottoming out of implants
Key risks include;
- Skin- Your skin may not be able to cope with the size of the implant you want.
- Ptosis – Ptosis refers to drooping or sagging. If you have ptosis you may have needed to get a Breast Lift (Mastopexy) along with your implants to address your drooping skin and nipple position. (A good surgeon will tell you if you need a combined procedure)
- Pocket – The shape or size and placement if done by a less-trained Surgeon.
Choosing Breast Implants that are very large (for your skin condition) or implants that are placed too low can sometimes bottom out.
You may notice the following if you are experiencing bottoming out:
- Your nipple is pointing more upward than forward.
- The lower pole or bottom of your breast appears to bulge slightly downward.
- The space between your nipple and your infra-mammary fold (IMF or breast crease) appears “stretched”
- if you believe you are experiencing any of these it’s vital that you get a proper assessment and review from your plastic surgeon. Do not self-diagnose, call your surgeon and book an appointment.
Bottoming Out vs Descending Breasts
Compare bottoming out (as above) to normal breasts descending:
- Normal descending or skin ptosis can happen naturally due to age, after pregnancy, weight loss and breastfeeding.
- Bottoming out occurs when your skin can’t support the size of the breast implant or its position.
Breasts with skin ptosis do not bulge out at the bottom. The nipple also points down not upwards.
When bottoming out occurs, there’s an imbalance between the upper and lower pole projection (volume). As opposed to descending, when the skin droops there is a lack of shape rather than shape imbalance.
Can ‘Bottoming Out’ be fixed?
In short, yes. However, it is not an easy fix. When bottoming out occurs you will need to undergo revision surgery to correct it. This can involve implant removal, implant exchange as well as the use of Mastopexy techniques to lift the breasts and nipples.
- Revision surgery for bottoming out can be a two or sometimes three-step process.
- You may need to have your breast implants removed and breast pockets given time to heal, meaning an implant will not be placed back immediately. Learn more about the Pros and Cons of Breast Implant Removal.
- After you have adequately healed, new breast implants will be inserted. However, added precautions may be needed to assist in supporting the weight of the implant.
- You may need to have your implant size adjusted. This can help reduce future risks of bottoming out.
- However, If you have loose skin or skin that doesn’t have great Elasticity (low skin collagen), you might need to evaluate your options. You might need smaller implants or a breast lift. You can get a breast lift with or without breast implants.
9 Steps to reduce the risks of ‘Bottoming Out’
STEP 1. Choose a skilled surgeon
- Choose an expert, someone who specialises in Breast Augmentation.
- A Specialist will be able to give you recommendations.
- You should at least consider their recommendations, especially if they suggest small or moderate enlargements or a combination of Breast Lift and Augmentation.
STEP 2. Know your own body
- Ask your surgeon about what your skin strength limitations are.
- Is your preferred size possible?
- Do you have signs of skin laxity on your breasts? (stretch marks/ ptosis etc) if you do your surgeon should take this into account and they should mention it to you as well as take precautions against ‘bottoming out’
- If they don’t ask you need to raise this risk question during your consultation.
- The risk of Bottoming out can not be completely removed, but it can be reduced.
STEP 3. Discuss and evaluate different positions with your surgeon
- Different surgeons use different techniques when it comes to implants.
- Some feel that sub-muscular implant placement can reduce bottoming-out risks, for select patients. However, each Surgeon has a unique view.
- Furthermore, whilst having your implant placed under the pectoralis muscle can reduce the risk of bottoming out, it might not be the best technique for your appearance goals.
- You should also ask your Surgeon if an armpit incision, also known as a transaxillary incision, is an option for you
STEP 4. Be wary of using exceptionally large implants if you have skin laxity
- Choose an implant that is proportionate.
- Small to moderate in size; and not excessive in size or weight.
- Larger implants on a small frame can put unnecessary stress and pressure on your breast tissue.
- Furthermore, large implants, with skin laxity have been linked to a higher risk of Bottoming out.
STEP 5. Check satisfaction rates with silicone implants
- Silicone implants are not as dense as saline implants, due to this, ‘bottoming out’ is less likely.
- Lighter/smaller implants that are placed appropriately can help reduce the chances of ‘bottoming out’.
STEP 6. Follow your post-op instructions
- Follow the recovery guidelines laid out by your surgeon
- Wear the recommended support garments and bras (24/7)
- Do not rush back into your exercise routine or high-impact activities.
- It’s crucial to let your body rest and recover after surgery.
- Prevention can go a long way
STEP 7. Review the effectiveness of cellular dermal matrices and other internal bra techniques
- Dermal matrices are used by some surgeons for reconstructive surgery.
- The uses of dermal matrices significantly increases surgery costs.
- Other surgeons may use special suturing and internal bra techniques to help reduce the chances of bottoming out risks
STEP 8. Anchoring sutures
- Anchoring sutures are used by some not all Surgeons.
- These assist in securing the deep connective tissues of your breast to the connective tissues of your chest wall.
- This can create a temporary barrier while the implant is healing.
- It may also help reduce the chances of the implant settling too far down.
STEP 9. Capsular adherence
- Different textured implants have different pros and cons.
- Some breast implants might adhere better to internal tissue. This can be due to shell texture.
- This can lead to better adhesion. in other words, it can help hold implants in position if you have skin laxity.
At the end of the day, it’s important to remember that every patient is different. The last thing you want is to have a second surgery to correct the first one. You can either blindly hope for the best or you can be informed and realistic. We, of course, recommend that you do your research and take every precaution to get an excellent result.
About Dr Craig Rubinstein
Dr Craig Rubinstein FRACS (Fellow of the Royal Australasian College of Surgeons) is an experienced Melbourne Specialist Plastic Surgeon for breast and abdominoplasty surgery.
Dr Rubinstein offers women personalised abdominoplasty surgery and all forms of cosmetic breast surgery.
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