According to the American Society of Plastic Surgeons, more than 310,000 breast augmentations were performed in 2018. While the vast majority of patients successfully undergo this popular procedure without any complications, some may experience what’s known within the industry as “bottoming out.”

The Journal of the American Society of Plastic Surgeons defines this as “a complication of breast implant surgery that consists of the descent of the inframammary fold with inferior displacement of the implant, causing breast asymmetry. Release of the lower pole for adjustment of the inframammary fold can result in insufficient capsular support, and the downward pectoral muscle action can contribute to push and keep the implant in a lower position.”

 

What causes bottoming out?

There are multiple reasons this may occur:

Inexperienced Surgeon

In most states, physicians and surgeons don’t have to be certified in plastic surgery to perform these procedures, so it’s important to choose one with such credentials who is associated with accredited organizations. If you enlist a non-board certified surgeon, there’s a higher likelihood complications will occur. 

An inexperienced surgeon can over dissect the implant pocket, causing the implant to move around and push downward inside. 

If you experience an implant bottoming out, you should contact a board-certified plastic surgeon immediately.

 

Too Large or Heavy Implants

Sometimes your skin can’t handle the weight of a large or heavy implant, resulting in bottoming out. It’s important to discuss the right size and type for your body with a certified plastic surgeon. Heavier implants hold a higher risk than smaller for this complication. 

 

Weak Tissue & Skin Laxity

If you’ve recently experienced dramatic weight loss, pregnancy, been nursing, or are a smoker you may have thinning, saggy skin and weak muscle tissue in your breast area that can contribute to bottoming out. A board-certified surgeon will test your laxity and suggest additional reinforcements to hold the implant in place. 

 

What does it look like?

If you observe these signs, you are most likely experiencing bottoming out:

  • There is an imbalance in the post-operation breast shape. 
  • The lower pole appears longer. 
  • Nipples point upward rather than facing central and forward. 
  • An increased distance between the nipple and inframammary fold exists.
  • The bottom of the breast appears to bulge downward.

Although bottoming out and sagging skin—which occurs naturally with age—can seem similar, the two are different. Normal skin sagging, also known as skin ptosis, appears droopy and empty. It won’t bulge at the bottom, and nipples will point downward.    

 

What should you do if you experience bottoming out?

If you experience an implant bottoming out, you should contact a board-certified plastic surgeon and schedule a reconstructive procedure. The nature of the corrective surgery will depend on what caused the bottom out and how bad it is. 

Depending on the extent of the descent, the implant may need to be removed, possibly replaced with a smaller implant, and re-augmented. Other cases may require the surgeon to reopen the original augmentation incision to reposition the implant and tighten the breast fold, ensuring the nipple is moved upward. If caused by an over-dissected implant pocket,  the procedure may involve adjusting the pocket to ensure proper healing. 

 

How to Prevent it?

Hiring only a board-certified and accredited plastic surgeon to perform a breast implant will help minimize the risks of bottoming out. Discuss the proper implant size and type with your surgeon, as well as how the procedure works. Disclose whether you’ve experienced any recent skin laxity, recently been pregnant, had excessive weight loss, or been nursing. This may alert them to the possibility of internal tissue weakness. 

After breast augmentation, be sure to follow the post-op instructions given to you by your plastic surgeon. Get your rest, don’t rush back into exercise or excessive activity, and avoid heavy lifting. After surgery, wearing supportive undergarments is a must.


If your implant has bottomed out, Dr. Anthony Buglino can help. As a board-certified he has expertly performed breast augmentations and corrective breast surgery with great success and patient satisfaction. Reach out today for a free consultation.