Bottoming Out Breast Implant

Breast implant bottoming out occurs when the bottom of the implant slips below the crease where the breast meets the chest wall (the inframammary crease).
Bottoming out is not the same as the natural dropping and settling in that occurs after a breast augmentation.
A bottomed-out breast implant can be fixed, but steps must be taken during the repair to make sure the underlying issues are resolved so the implant doesn’t bottom out again.
Woman supporting the underside of her breast with one hand, illustrating a bottoming out breast implant

What is Breast Implant Bottoming Out?

Bottoming out is a type of breast implant displacement or malposition in which the implant drops too low on the chest and extends below the intended inframammary fold, or breast crease. As the implant descends, the lower portion of the breast may become disproportionately full or elongated. In the natural aging process, the nipple goes along with descending breast tissue, but it may not when a breast implant bottoms out. The result is a breast that is overly full at the bottom with a nipple that appears too high on the chest and likely points upward rather than forward.

Breast implant bottoming out can affect both breasts or just one. It occurs with both saline and silicone implants, and it can happen shortly after your breast augmentation or years later. Bottoming out is not the same as the normal drop and fluff process expected after breast augmentation. True bottoming out means the implant has moved beyond the intended lower boundary of the breast pocket.

How Can You Tell If a Breast Implant Has Bottomed Out?

Usually, you know a breast implant has bottomed out based on the appearance of the breast, but the issue can also be physically uncomfortable. Sometimes patients complain of aching or heaviness in their lower breast. This sensation may ease when wearing a supportive bra. A pulling, stretching sensation is also possible, and some patients can feel the breast implant and know that it is sitting too low.

For many other patients, the signs that an implant has bottomed out are more visual and may appear as follows:

  • The breast crease looks lower than it did after surgery
  • There is excessive fullness or length below the nipple
  • The nipple appears unusually high on the breast mound
  • The nipple angles upward, sometimes creating a “stargazer” appearance
  • Upper-pole fullness decreases while the lower breast becomes fuller
  • One breast begins sitting noticeably lower than the other
  • The breast looks elongated or disproportionately bottom-heavy

Bottoming Out vs. Double Bubble

Patients often confuse bottoming out with double bubble breast deformity, and it’s easy to do since the conditions are related. But they are not the same, and we don’t use the terms interchangeably. A double bubble deformity creates a visible second crease or contour across the lower breast. If you think of the curve at the bottom of your breast as a smile, a double bubble deformity essentially creates a double chin.

Bottoming out can create a double bubble deformity, but a double bubble deformity can also indicate other issues. Sometimes the breast implant stays in place while the breast tissue around it shifts downward. Don’t assume your breast implant is bottoming out based on a double bubble alone, and don’t assume your implant hasn’t become displaced just because you don’t have a double bubble.

Why Do Breast Implants Bottom Out?

There are usually multiple factors at play when a breast implant bottoms out rather than a single issue. Chest trauma can cause an implant to bottom out, as can placing excessive strain on the area while healing from your breast augmentation. Your unique anatomy and chest wall can also play a part. But there are a few primary reasons why implants bottom out.

Implant Size and Weight

Large, heavy implants are often a contributing factor for bottoming out breast implants. There is no specific implant size that is generally too big, but there are implants that are too big for you. Heavier implants exert more downward force on the lower breast, and you need to have enough support to keep them in place. If you lack adequate breast tissue, tissue quality, or chest width relative to the size of your implants, the risk of them bottoming out greatly increases.

Skin and Tissue Quality

If your breast skin or tissue is already very elastic, thin, or stretched, it may not be able to adequately support a breast implant. Pregnancy, breastfeeding, significant weight loss, aging, genetics, and previous operations can all negatively affect tissue quality. You and your plastic surgeon must take this factor into account when choosing the right implant for you and planning your surgery. Skin and tissue quality often determine how big of an implant your body can support without bottoming out.

Implant Pocket and Breast Fold Support

During breast augmentation, your plastic surgeon will create a pocket for your implant to sit in. If the pocket is improperly sized, sits too low, weakens, or stretches, the implant becomes much more likely to bottom out. If this happens, simply replacing the implants isn’t an adequate solution. Replacing the implants without addressing pocket issues leads to the breast implant bottoming out again.

Can a Bottomed-Out Breast Implant Be Fixed?

The good news is that we can fix a bottomed-out breast implant with breast implant revision surgery. The exact details of your surgery will depend on why your implant bottomed out. We determine why your implant bottomed out and address the underlying issue in the hope that your implant won’t bottom out again. Surgery may include several of the following:

  • Tightening the lower portion of the implant pocket with internal sutures (capsulorrhaphy)
  • Re-establishing or raising the inframammary fold
  • Closing off part of an oversized or stretched implant pocket
  • Creating a new implant pocket
  • Reinforcing weak tissue with an internal support material or mesh
  • Exchanging the implant for a smaller or lighter implant
  • Combining revision with a breast lift to address stretched breast tissue or significant sagging
  • Removing the implants if you no longer want them

What If the Implant Has Bottomed Out More Than Once?

We may be able to stop your breast implants from bottoming out even if it’s happened more than once. Simply moving the same implant upward without correcting the reason the pocket failed leaves the patient vulnerable to recurrence. If your breast implant has bottomed out more than once, we will reassess all of the following to determine why:

  • Implant size and weight
  • Remaining breast tissue quality
  • Integrity of the inframammary fold
  • Size and shape of the implant pocket
  • Previous surgical techniques

Frankly, we believe in assessing these traits in every patient whose breast implants bottom out, whether it’s the first time or not. Our goal is always to find and fix the underlying issue, not hike up your current implants and hope for the best!

Can Bottoming Out Be Prevented or Slowed?

The human body throws even seasoned plastic surgeons a curve ball every now and then, but experienced plastic surgeons can sometimes prevent breast implants from bottoming out. We can’t do it without your help, though. When planning your initial breast augmentation surgery or implant revision surgery, and while carrying it out, we reduce risks by:

  • Choosing implant dimensions appropriate for your anatomy
  • Preserving and reconstructing the inframammary fold appropriately
  • Avoiding an unnecessarily large implant pocket
  • Accounting for existing tissue laxity and breast ptosis (sagging)
  • Using additional pocket support in high-risk patients

After surgery, we need your help in preventing your breast implants from bottoming out. You can help prevent issues by:

  • Following postoperative activity restrictions closely
  • Wearing the surgical or supportive bra recommended by your surgeon
  • Avoiding a premature return to high-impact activity and upper-body exercise
  • Attending scheduled follow-up appointments so we can evaluate implant position over time

Frequently Asked Questions

Breast implants bottom out frequently enough that plastic surgeons are aware of the possibility, but it remains a fairly uncommon phenomenon. While surgical technique, patient anatomy, implant characteristics, and post-op care are all factors, implants generally bottom out in only 1 or 2% of breast augmentation cases.

No. Surgical errors can cause bottoming out, but breast implant displacement can happen even when your plastic surgeon does everything right. Tissue quality, implant size, pregnancy, weight changes, aging, post-op behavior, previous surgery, healing course, and many other factors play a role in bottoming out.

If a bottomed-out implant isn’t causing you any pain or physical problems, you technically don’t need to fix it. However, if you don’t, you will continue to live with any physical deformities created by the implant and its position could slip even lower. It’s best to have a bottomed-out implant examined by a plastic surgeon so you know how far your implant has slipped and how things might change moving forward.

Sometimes breast implants bottom out during recovery or shortly after a breast augmentation. But bottoming out has no time limit. You could experience breast implant malposition even if you’ve had your implants for many years. Gradual tissue thinning from age, weight fluctuations, gravity, and pregnancy can all cause an initially stable implant to shift.

It is very possible for one breast implant to remain stable while the other bottoms out. You probably tend to think of your breasts as a set, but each can have its own distinct tissue strength, pocket dimensions, breast fold anatomy, and preexisting asymmetry.

Yes, breast implants can bottom out even if you had a lift along with your breast augmentation. A breast lift indicates that loose or stretched breast skin and tissue may already have been a problem for you. If you need a lift, your plastic surgeon should take that into account when planning the breast augmentation or revision aspect of your surgery.

Not at all. Bottoming out simply means that the position of your breast implant has changed or shifted. A rupture occurs when the outer shell of the breast implant is torn or compromised. Ruptures can be difficult to detect in gummy bear implants but often lead to rapid breast deflation with saline implants. A displaced implant can and often does remain entirely intact.

You could, but new breast implants aren’t always necessary. Sometimes surgeons can reposition the existing implant. Replacing the implants is common, however, particularly when there is a size concern.

Good support can help reduce strain on the lower breasts, but not enough to stop a shifting implant from bottoming out or move it back into its proper place. If the shift in your implant is causing pain or discomfort, a supportive bra may ease the sensation, but it won’t correct the problem.

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