Medically reviewed by David Bogue, MD, board-certified plastic surgeon.
Your implant seems lower, the bottom of your breast looks longer, or your nipple appears higher on the breast than it used to. Is the implant settling—or moving too far?
“Bottoming out” describes an implant that has moved too low as the pocket or support beneath it stretches or gives way. An examination helps distinguish this from normal healing, breast-tissue sagging and other changes in implant position. A photograph alone cannot reliably make that distinction.
What Does a Bottomed-Out Implant Look Like?
Possible signs include:
- More distance between the nipple and the crease beneath the breast.
- Excess fullness or stretching in the lower part of the breast.
- A nipple that appears unusually high relative to the implant.
- One implant sitting lower than the other.
These observations are reasons for an assessment, not proof that an implant has bottomed out. Your starting anatomy, time since surgery and changes over time all matter.
Settling, Sagging or Bottoming Out?
The breasts change as swelling resolves after augmentation. A lower or softer appearance during healing does not automatically mean there is a complication.
Breast tissue can also sag over an implant that remains in an appropriate position. That is a different problem from an implant moving too low. Sometimes both are present. Dr. Bogue evaluates the implant, breast fold, skin, tissue and nipple position together before recommending treatment.
Why Can an Implant Move Too Low?
The implant pocket and the support at the lower breast fold help determine where an implant sits. Stretched tissues, an implant that places too much demand on those tissues, or disruption of the fold can contribute to downward movement. Previous surgery and changes in the breasts over time can also affect support.
Implant placement above or below the muscle is one part of the overall plan. Placement beneath the muscle does not guarantee that an implant will stay in position. The strength of the chest muscle alone does not explain the problem.
Can You Reduce the Risk of Bottoming Out?
Start with an implant plan that accounts for your breast width, skin and tissue support—not just the amount of fullness you want. Implant size involves more than cc; dimensions and the demands an implant places on your tissues matter too.
Discuss prior surgery and changes in your breasts with your surgeon. After surgery, follow your individualized instructions for activity, support garments and follow-up. These steps support recovery, but no implant size, placement technique or bra can guarantee that bottoming out will not occur.
How Can Breast Implant Revision Help?
Treatment depends on what has changed. Breast implant revision may involve rebuilding or tightening the pocket and restoring support at the fold. Implant size, type or placement may also be reconsidered.
If the implants feel too large, a smaller implant may be part of the plan. If the breast tissue itself has also dropped, a breast lift may address that separate concern. A lift is not automatically needed for every implant-position problem.
The surgical plan should address the underlying cause of the position change. Revision has risks, and position problems can recur; the proposed operation and its limitations should be discussed before deciding.
What Should I Do if I Notice a Change?
Contact your surgeon for an assessment, particularly if the difference is new or progressing. If you recently had surgery, follow your surgeon’s instructions about support garments, exercise and follow-up. Avoid trying to reposition an implant through massage, exercises or a different bra without guidance.
For a new change accompanied by significant pain, redness, warmth, rapid swelling or fever, contact your surgical team promptly rather than waiting for a routine cosmetic consultation.
Bring any available implant card and prior operative information to your visit. You can also review Dr. Bogue’s published revision results on the website. Individual results vary.
To discuss an implant-position concern with Dr. Bogue in Boca Raton, call 561-886-1000 or request a consultation.