How To Correct Bottoming Out after Breast Augmentation

Posted on Thursday, May 31st, 2012 by Dr. Babak Dadvand

Breast augmentation is a very common operation that can greatly enhance a woman’s life. But with all surgeries, there are complications that can occur. Bottoming out is a term seen on many breast implant forums and websites but what is it really, what causes it, and how can it be fixed?

Bottoming out occurs when the implant sits below the natural breast position. This leads to the nipples looking too high and too much skin show below the nipple. It is more common in women with smaller breasts and poorer skin tone, as well as when the implants are placed over the muscle and when the breast implants are too large for the patient’s tissues to support..

Bottoming out is caused by 2 things. If it occurs soon after surgery, it is because of over-dissection of the implant pocket. If it occurs after some time, then it is due to the weight of the implants stretching out the bottom portion of the breast.

Correcting bottoming out is intuitively very straightforward but advanced techniques or products may need to be used to obtain long-lasting results. One type of repair is to use the patient’s own internal scar tissue and place internal sutures to close off the bottom part of the breast pocket so the implant does not drop down into that area. In my experience, just using internal sutures is not a guarantee of long-lasting results because these patients typically have thinned out tissue that over time may be stretched out again. A new technique that I use is the placement of Strattice in addition to the internal sutures. This creates an internal hammock and is a much more sturdy repair than just relying on internal sutures that were placed in thinned out tissues.

Below is an example of a patient who came to me with significant bottoming out. She had implants placed over the muscle. You can see how low her breasts look on her chest and how high her nipples look. I performed a bottoming out repair by closing of the bottom portion of the implant pocket and reinforcing it. Notice the proper position of her nipples now, as well as the much improved fullness to her upper poles now that the implants are centered behind and not below her nipples.

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