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The Ins and Outs of Bottoming Out

Mar. 07, 2012 by Dr. Frank | 2 Comments

Breast implant complications are fortunately fairly rare. Risks such as implant deflation and buildup of excessive scar tissue –which plastic surgeons call capsular contracture- are often discussed with patients preoperatively and their incidence is widely reported in the plastic surgery literature. Less often discussed but perhaps even more frequent is breast implant displacement which is often referred to as bottoming out.

What Does It Mean To “Bottom Out?”

When an implant “bottoms out” it slips to a lower position on the chest wall. This can sometimes give the patient a “double bubble” appearance at the bottom of the breast and sometimes can give the appearance that the nipple is pointing up. Unfortunately, patients with implants are never completely immune from bottoming out but knowing the risk factors can often prevent its development.

Bottoming Out Diagram



Large Implants and Weak Tissue

Bottoming can be caused by any size implant which, given its weight, will tend to drop over time. Obviously, larger implants stand this risk more than smaller implants although there is no hard and fast definition of a “large” implant. The problem is exacerbated in patients with weak tissues such as those who:

  • Smoke
  • Have been on steroids
  • Have lost large amounts of weight
  • Have “high risk” occupations-exotic dancers who frequently work without the support of a bra
  • Have “high risk” hobbies-activities that involve a great deal of bouncing such horseback riding or running.

Surgeon Error

Unfortunately, bottoming out can also be caused by surgeon error. The crease under the breast is an important anatomic landmark in breast surgery. While sometimes this crease needs to be lowered in order for the implant to be centered on the nipple, altering this crease must be done with the understanding that this increases the patient’s risk of bottoming out. Lowering the crease too low will result in bottoming out immediately after surgery but any disruption of the crease can increase ones chances of problems down the road.


Implants Placed Over The Muscle

Surgeons unfamiliar with this problem can also make matters worse by placing implants over the muscle or by treating the problem by simply using a bigger implant. Implants placed over the muscle are much more likely to experience bottoming out when compared to those placed under the muscle. A bigger-and thus wider implant- will give the short term illusion that the implant is better centered on the breast, but over time the problem will get worse with the heavier device.


I have a particular interest in breast implant displacement having worked extensively on the problem for over 10 years. My work on particularly difficult patients who have failed treatment with multiple surgeons gave me the idea for a supportive sling placed under the implant – a sort of internal bra. This idea and its development, led to issuance of two US Patents for a device and procedure that has attracted the attention of several international medical device manufacturers. Patients from all over the country have traveled to Chicago to be treated and the results continue to be excellent.

If you have any additional questions regarding revisional breast surgery or if you’d like to learn more about the rest of our procedures, just give us a call (219) 513-2015. We look forward to hearing from you.

2 thoughts on “The Ins and Outs of Bottoming Out

  1. Hi i would like some information on the correction of bottoming out please. Such as what the surgery entails and its costs. Thank you.

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