Bottoming Out after Breast Augmentation

What is Bottoming Out?

Bottoming out occurs when the implants descend below the inframammary fold (crease). It is very easy to spot since the nipples and areola are located high on the breast mound. Bottoming out is most prominent when the implants are placed in the subglandular or partial submuscular position. In these two positions, the bottom of the implant is supported only by the breast tissues and skin. It is impossible to know in advance who has weak tissues and who does not. A woman may have a lot of tissue, but it may be weak, and another woman may have very little tissue, but it may be stronger.

When the implants are placed in the “complete” submuscular position, the fascia, which is very strong, fibrous, connective tissue, supports the weight of the implant, and acts as an internal bra. Breast implants placed in teh subfascial position are also supported by the fascia. These two positions allow for a much lesser risk of bottoming out.

Bottoming out can happen over a period of time, meaning that over time, the weight of the implant weakens the tissues, and bottoming out results. It can also happen due to surgeon mishap. If the bottom of the pocket is overdissected, bottoming out can occur early on in the recovery process.

Most of the time, the crease needs to be lowered during breast augmentation surgery. This is very common. In the case of small implants, the crease may not need to be lowered. But, if you’re starting out with very little breast tissue, and you are going from an A to a D cup, the crease has to be moved downard. If it isn’t, the implants will sit too high on the chest, meaning that the nipples will be too low on the breast mound. The crease can be lowered, and most of the time it does not result in bottoming out.

Bottoming out is sometimes seen in conjunction with capsular contracture or coupled with symmastia.

Related: Bottoming Out Revision Surgery and Bottoming out Repair