What Bottoming Out Is & Isn’t
Bottoming out is technically when the breast implant sinks below the inframammary fold or crease of the breast. The inframammary fold is the tissue where the breast meets the abdomen also known as the crease of the breast.
It's important to note that your implant hasn't bottomed out if it isn't below that crease. If your incision migrates upwards on the breast over time, which can happen occasionally with a crease incision, your implant has not bottomed out. The scar has moved, not the implant.
There isn’t a single cause that leads to a breast implant bottoming out.
But there are some factors that play into your chances, like the type of incision used for your breast augmentation (learn more about breast augmentation incisions and scars in the free Bustmob Academy app).
In the event that your implant bottoms out, it can be corrected with surgery.
How do you know if you’re bottoming out?
For starters, your implant will be beneath the crease of your breast. Women typically will feel discomfort that is a bit hard to explain. It usually isn’t described as “painful” but rather like the implant is in the wrong place, which it is.
You may find some relief when you’re wearing a bra and find it doesn’t feel great without one. You may also feel as though you need to “hold up your implant.”
If you feel like your implant is bottoming out, give your plastic surgeon a call to schedule an appointment. They’ll do an exam to confirm whether you are indeed bottoming out, or not, and go from there.
How can it be corrected?
The only way to correct an implant that has bottomed out is with additional surgery. During the procedure, your plastic surgeon will temporarily remove the implant and fix the fold with a suture or cautery. In some cases, your plastic surgeon will reinforce the area using a mesh.
They’ll also often ask that you wear an underwire or supportive bra 6-12 weeks after surgery. As board-certified plastic surgeon of Amelia Aesthetics, Dr. Michelle Roughton suggests, think of the bra as a sort of “belts and suspenders” approach.
What bottoming out isn’t
In some cases, a crease incision may migrate or move up on the breast over time, but that doesn't indicate your implant dropping. Why? Because the implant itself hasn’t moved. The scar has.
A bottomed out implant only happens when the breast implant has been displaced and is below the crease of the breast.
What causes it?
To be completely honest, there isn’t a cause that is known to be solely responsible for why an implant bottoms out. What’s likely is that bottoming out is a mix of risk factors and a touch of bad luck.
Some risk factors include:
- Loose connective tissue
- Larger volume implants
- Type of incision
- Suture failure
- Surgeon error
- Exercising too soon after surgery
Some people naturally have connective tissue that just isn’t as strong. However, the most common patients with loose connective tissue are those who have had major weight loss (over 100 lbs).
In this case, before the weight loss, the skin was more stretched out than it is after the patient has lost the weight, which typically leaves these patients not having as strong of connective tissue.
Another factor is large breast implants. There is no magic number that makes a breast implant “a large volume implant.” But the larger the implant, the heavier it is, which adds pressure to that fold. More pressure means a higher chance of a bottomed out implant.
The type of incision also plays a role. A crease or inframammary incision is more likely to bottom out than say a transaxillary incision, through the armpit, or periareolar incision, around the nipple.
A suture giving way or the surgeon not closing the incision well can also lead to a bottomed out breast implant. Even so, the crease incision is still a very popular incision in the Bustmob Community, a private, women-only plastic surgery support group.
If you’re wondering if you should do a plank 3 weeks after surgery, the answer is no. Loading the pectoral major chest muscle before the capsule has formed (around 6 weeks post-op) can cause the implant to bottom out.
Because the breast pocket or capsule around the implant has not fully formed, planks, heavy lifting, pull-ups, and push-ups can cause the chest muscle to push the implant down and out.
If you have concerns about bottoming out, be sure to ask your plastic surgeon during your one-on-one consultation. Based on your physical exam and your aesthetic goals, they will be able to discuss your specific breast augmentation surgery risks and benefits.
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