Bottoming Out and Breast Implants

03 January, 2020 Nurse Justine

What is Bottoming Out?

Bottoming out is another dirty word in the postop breast recovery world. It’s natural and expected for your breast implants to drop slightly after surgery AKA The Drop and Fluff. But, if there is an imbalance in the breast, your implants may bottom out where they drop well beyond what is expected. This causes the breast area below the nipple to appear super long and the nipple will to sit too high on the breast, pointing upwards.

What Causes Bottoming Out?

  • Poor skin quality
  • Large volume implants
  • You needed a breast lift (mastopexy) but only got breast implants
  • The breast pocket dissected for the implant has been made too large or the breast implants were not placed in the correct position
  • Overuse of the pectoral muscles too early in your recovery

    And...

NOT WEARING THE RECOMMENDED BRA FOR FOR THE RECOMMENDED TIME & NOT FOLLOWING THE POSTOP INSTRUCTIONS

After you have implants inserted, it takes approximately 3 months for the capsule to form around the foreign object. This capsule will help hold your implants in place. Until this capsule is formed, the only thing providing support to your girls is your bra. This is particularly important when doing activities that involve your pectoral muscles (lifting your arms, pushing, pulling, etc). The pectoral muscles will contract and push on the implant. If there is no capsule or bra in place for support there is only one direction for the implant to go...downwards.

How to Correct Bottoming Out?

Correction of bottoming out usually requires additional surgery, implants are removed, and the pockets may be tightened. Sometimes an internal bra or mesh is fitted. A breast lift may need to be performed in conjunction to remove excess skin and reposition the nipple.

Bottoming Out Vs The Drop & Fluff

All breast implants will settle into their position within the breast pocket, you may recognise this term as Drop and Fluff. This process can take 3 – 6 months. After surgery, you will be swollen, and your breasts may initially look larger (particularly in the upper pole) and more projected. Once this swelling subsides and the fullness in the lower pole rounds some patients mistake this for bottoming out.

Now, to ease the minds of any patients worrying they might be bottoming out - I have included some pictures of confirmed cases I have found online below :)

- Nurse Justine

Bottoming Out

Sourced from: Mañero, I., Montull, P., & Guisantes, E. (2009). Bottoming Out: A Simple Technique for Correcting Breast Implant Displacement. Plastic And Reconstructive Surgery, 124(6), 452e-453e. doi: 10.1097/prs.0b013e3181bcf578.

Bottoming Out

Bottoming out due to gravity, and weight of implants.

Sourced from: Georgiade, N., Georgiade, G., & Riefkohl, R. (1990). Aesthetic surgery of the breast. Philadelphia: Saunders.

Bottoming Out

Bottoming out due to excess breast tissue. A straight forward breast augmentation was performed without a lift, which was required.

Sourced from: Georgiade, N., Georgiade, G., & Riefkohl, R. (1990). Aesthetic surgery of the breast. Philadelphia: Saunders.

Bottoming Out

Bottoming out due to over dissection of breast pockets.

Sourced from: Georgiade, N., Georgiade, G., & Riefkohl, R. (1990). Aesthetic surgery of the breast. Philadelphia: Saunders.

More Information

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justine@drchinsee.com.au