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Breast Implants: How To Reduce Bottoming Out

Apr 20, 2019 | Breast

Breast augmentation surgery is one of the most popular and safe cosmetic procedures performed each day in Beverly Hills. It is a plastic surgery that uses a saline or silicone breast implant to enhance the size, shape, and look of the breasts. Most women who undergo this treatment love their results and the vast majority do not have complications. However, there is sometimes the possibility of a complication occurring. Even though it is rare, some women will have what is known as a “bottoming out” implant.


"Bottoming out" occurs when a new implant loses internal support (i.e., the underlying muscle is too weak or your skin cannot hold it in place properly). This causes it to sink down toward the lower part of the breast area. Common symptoms of a bottoming out breast implant include:

  • An increase in the distance between the nipple and inframammary fold
  • An appearance of the bottom of the breast tissue bulging downward
  • Nipples appearing as though they're pointing upward, rather than forward

The most common cause of bottoming out is weakness and a lack of elasticity in the breast tissue or skin, or both. When the tissue is strong and there is healthy elasticity, the breast implant will appear normal and symmetric on the chest wall. When there is weak tissue structure and poor elasticity, it is difficult for the implant to stay at a healthy position and it becomes easier for the implant to drop downward. This weakness can be caused by a number of issues, including a dramatic weight loss, pregnancy, nursing, aging, and smoking. In addition, one of the larger areas of concern for implants that bottom out, is physician error.

Let’s take a further look on how to reduce implant bottoming out.



One of the best things you can do to prevent bottoming out is ensure you're working with an experienced board-certified Beverly Hills plastic surgeon who will get things right the first time. Make sure your surgeon is board certified and experienced with all types of breast augmentation surgeries. Look at his or her past work to make sure they'll yield the results you're looking for. It's also important to work with a surgeon who doesn't pressure you to choose implants bigger than what you're comfortable with. The surgeon should be very knowledgeable about the type of implant to use, where to place it, choosing an implant that is of appropriate size and weight, and not performing augmentation if an underlying issue exists. With a sea of plastic surgeons in the Beverly Hills area, it’s crucial you do your research so you find the right one who can deliver the results you desire.


Choosing the right implant for augmentation surgery is a big part of the consultation process. It is important to choose the proper size, shape, and texture to attain an appealing result. Smaller implants that are lighter in weight hold less risk for bottoming out while larger, heavier implants can ascend quicker and may hold a higher risk. In other words, sometimes, bigger is not always better. Implant type may matter in some cases. Silicone implants are less dense than saline implants. Because of this, they're less likely to bottom out. Implant texture and surface can also help keep the implant in place. All of these factors can be discussed during the consultation and during implant selection. If bottoming out is a concern, this should be discussed in detail at this time.


In most breast augmentation cases, the implant will be placed under the pectoral muscle (known as submuscularly). Placement of the implant under the pectoral muscle rather than on top helps support and keep the implant in proper position. When breast implants are placed on top of the muscle rather than submuscularly, bottoming out is more likely.


Visible, obvious breast sag and poor skin laxity can potentially lead to bottoming out if an implant is placed in a sagging breast. Many times, this can be seen before you even consider implants. If a surgeon places implants in a sagging breast, or one that has a weak structure or poor laxity, the risk increases for issues, including bottoming out.


Have you recently lost a lot of weight or just finished breastfeeding your baby? Have you noticed the skin on your chest has become thinner and weaker overall due to aging or nursing? These changes can be visible on the surface and also underneath. Discuss these issues with your breast surgeon and ask if breast augmentation is right for you. If your chances of bottoming out are high, then a breast lift or another type of reconstructive surgery may need to occur first before placement of the implant.


Following all of your surgeon's post-op instructions will also significantly lower your chances of experiencing a bottoming out implant. Some of the most important instructions to heed include:

  • Get plenty of rest
  • Don't rush back into exercise or high-impact activities
  • Wear supportive bras and garments
  • Avoid heavy lifting

Consistently wearing a supportive bra is particularly important, especially if you opted for very large implants. This will help keep your breasts in place while your muscles adjust to the additional weight.


The only option to remedy bottoming out implants is to undergo corrective surgery, typically in the form of a breast revision or breast lift procedure. Sometimes, before this procedure can take place, you'll need to have your implants removed to let your breast tissue and the pockets heal. To support the weight of the new implant, the surgeon will likely perform some type of reconstruction using an anchoring structure, a matrice, or possibly a graft. The pocket that holds the implant will also be surgically reshaped to hold and support a new implant. The goal is to get the surgery right the first time so that bottoming out is not an issue for you.

Now that you know what breast implant bottoming out is and how to prevent it, you may be ready to talk further about breast augmentation surgery. If you live Beverly Hills, contact board-certified plastic surgeon Dr. Jaime Schwartz to schedule your consultation and learn more about what you can do to ensure a successful procedure.



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