Breast Augmentation is a popular cosmetic procedure that helps many women feel more confident. With a board-certified plastic surgeon that specializes in breasts, the complication rate of the breast augmentation is low, and satisfaction is high. However, even with the best surgeon, there are factors beyond a surgeon’s control that can lead to aesthetic complications. One of those complications is “bottoming out.”
The proper term for bottoming out is Soft Tissue Stretch. Soft tissue stretch occurs when the skin of the lower pole thins out, causing the implant to drop below the crease of the breast. This condition can happen for several reasons, including poor surgical technique, choosing an implant that does not fit the patient’s tissues, or it is a product of a person’s preexisting breast anatomy or skin quality.
Understanding what causes soft tissue stretch, how to recognize it, and what can be done about it can help anyone considering breast augmentation or dealing with related implant concerns.
Understanding “Bottoming Out” Breast Implants
Causes
Several factors can cause breast implants to bottom out. Some are related to the surgery itself, while others depend on a person’s body and lifestyle. Understanding these causes can help reduce the risk and improve results after breast augmentation.
Surgical Factors
- Over-Dissection of the Breast Pocket – During surgery, a pocket is created in the breast tissue to hold the implant. If this pocket is made too large or too low, the implant may not have enough support to stay in place.
- Implant Placement – Implants placed above the muscle (subglandular) have a higher chance of bottoming out compared to those placed under the muscle (submuscular). The muscle provides extra support, helping keep the implant in position.
- Improper Implants Selection – Choosing implants that do not fit the natural breast dimensions. Implants that are the wrong profile and/or are too large, put more strain on the tissue and compromise the skin integrity.
Patient-Specific Factors
- Thin or Weak Breast Tissue – Some people inherently have weaker skin and tissues, making it harder for the body to support an implant.
- Breast Shape – Preexisting anatomical factors like a tighter lower pole causes the skin to overstretch after the implant is placed, which can lead to malposition and contour irregularities.
- Aging and Skin Elasticity – The skin loses elasticity as we age, which results in sagging over time and an implant shift.
- Weight Changes – Gaining or losing a significant amount of weight can stretch or shrink breast tissue, affecting how well the implant stays in place.
- Post-Surgery Activity Levels – Lifting heavy objects, intense exercise, or improper support too soon after surgery can interfere with tissue healing and put strain on the breast pocket, creating soft tissue stretch.
Prevention starts with proper surgical planning, choosing an implant that fits the tissues, and following post-surgery guidelines.
Symptoms and Signs
Recognizing the signs of bottoming out early can help prevent further complications. Many people first notice changes in the shape or position of their breasts. Here are some of the most common symptoms:
Breast Appearance
- The lower pole of the breast appears overly full while the upper portion looks deflated.
- The nipple sits higher than normal or projects slightly upward.
- The inframammary incision moves upward away from the breast crease.
- The implant looks like it is sitting too low on the chest.
Breast Feeling
- The implant feels like it has more movement in the pocket.
- The implant edge may become more visible or feel more palpable under the skin.
- There may be a pulling or stretching sensation in the lower part of the breast.
Pain or Discomfort
- While rarely painful, some women experience discomfort from the implant shifting.
- Nerve sensations due to breast changes.
- The skin may feel tight or stretched, especially in the lower portion of the breast.
Women sometimes wonder why their new breast implants look saggy soon after surgery. While mild swelling and settling are normal in the healing and settling process, noticeable sagging or implant movement could be a sign of soft tissue stretch.
How to Help Prevent Breast Implants from Bottoming Out
While bottoming out can happen, there are ways to reduce the risk. Proper planning before surgery, expert surgical technique, and following post-surgical care instructions can all help prevent implants from shifting.
Pre-Surgical Considerations
- Choosing the Right Implant Size – Implants that are too large or heavy for a patient’s natural tissue increase the risk of bottoming out. A board-certified surgeon will recommend an appropriate size based on body type and skin elasticity.
- Assessing Tissue Strength – Women with thin or weak breast tissue may need extra support, such as a mesh or internal bra technique, to help hold the implants in place.
- Placing the Implant Under the Muscle – Submuscular placement (under the chest muscle) provides extra support, making it less likely for implants to bottom out compared to subglandular placement (above the muscle).
Surgical Techniques to Prevent Bottoming Out
- Proper Pocket Creation – The surgeon must carefully create the implant pocket to ensure it holds the implant securely. Over-dissection can lead to implants dropping too low.
- Inframammary Fold Reinforcement – Strengthening the crease under the breast during surgery can help support the implant and prevent downward movement.
- Internal Bra Support – Some surgeons use surgical mesh or sutures to reinforce the implant pocket and provide additional structure.
Post-Surgical Care
- Following Detailed Post-Operative Instructions – Your surgeon should provide you with diligent post-operative instructions and activity restrictions that you must adhere to. Post-op instructions not only ensure adequate healing but can also have an impact on the longer-term aesthetic result.
- Monitoring for Early Signs – Checking for subtle changes in implant position can help catch bottoming out before it gets worse. Regular follow-ups with a plastic surgeon can ensure that the implants are settling properly early on.
While some might wonder if soft tissue stretch can be fixed without surgery, prevention is the best approach. Once the implants have shifted significantly, non-surgical options are limited. Taking the right steps from the beginning can help maintain long-lasting results.
Treatment Options for Bottomed-Out Implants
When a breast implant bottoms out, treatment depends on how severe the issue is. Some cases may require surgery, while others can be managed with supportive measures. Identifying the right approach early can prevent further complications and restore the desired breast shape.
Surgical Solutions
Most cases of bottoming out require surgical correction. If the implant has shifted significantly, a surgeon can perform one or more of the following procedures:
- Inframammary Fold Repair – The surgeon tightens or reconstructs the lower breast crease to support the implant in its proper position. This may involve sutures or tissue reinforcement.
- Pocket Adjustment or Reinforcement – If the implant pocket is too large, the surgeon can adjust it by tightening the surrounding tissue or using surgical mesh (internal bra technique) to provide extra support.
- Implant Replacement – If the implant is too large or heavy for the patient’s breast tissue, a smaller implant may be recommended to reduce the risk of bottoming out again.
- Capsulorrhaphy (Internal Suturing) – This procedure involves placing stitches inside the breast to secure the implant and prevent future movement.
Can You Fix Bottoming Out Without Surgery?
Unfortunately, once an implant has moved significantly, non-surgical options are limited. However, in mild cases, some supportive measures may help:
- Wearing a Supportive Bra – A high-quality, well-fitted bra can help hold the implants in place and slow down further shifting.
- Monitoring for Changes – Regular check-ups with a plastic surgeon can help track any shifts in implant position and address concerns before they become severe.
While these steps may help in minor cases, surgery is often the only way to fully correct bottoming out once the implant has dropped below the breast crease. Acting early can improve results and prevent more complex revisions in the future.
