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Christopher K. Patronella, MD, FACS, FICS homepage


What Happens When An Implant Bottoms Out?

Posted April 11, 2024 in Breast Implant Replacement, Breast Implants, Breast Revision, Plastic Surgeon

By Dr. Chris Patronella

One of the most common areas of my practice is implant revision surgery. From time to time, I will see women who had breast augmentation surgery, and they require improvement in the position of their implants in order to have a more aesthetic, pleasing outcome.

One of the more common issues in this category is inframammary fold failure, also known as “bottoming out.” This is where the implant drops too low, lower than it was supposed to be, and lower than where the original incision was made to place the implant. And it requires a repair.

How Do You Fix Bottoming Out?

This bottoming out effect is primarily associated with under-the-muscle implants. And that is one of the disadvantages, I think, of placing implants under the muscle, although I still think it’s the preferred approach. Because this is an issue that I have seen over the years, when I do a primary breast augmentation, that is, when I place an implant for the first time in a patient, I will do a prophylactic fixation of the fold in order to prevent this problem from happening. For that  reason, I see very few of these cases in my own practice, but nevertheless, occasionally I do, or I see patients had breast augmentation elsewhere who come to see me because the position of their implants is not ideal, and they want it fixed.
One of the things that happens with inframammary fold failure/bottoming out is a loss of fullness in the upper part of the breast. Because the implant is too low, there is very little implant above the nipple. In addition, bottoming out causes the nipples to point upward. The nipples can actually peek out of a two-piece swimsuit, and that can be very annoying for women who have this. It’s not really the position of the nipple that is the problem but rather the position of the fold. Because when the distance between the nipple and the fold (also known as the vertical distance) elongates, it causes the nipples to move upward as the implant drops down.

For the patient featured in this video, I raised the fold about 3 centimeters or a a little over an inch, and her nipples now face forward. She has much better fullness in the upper part of the breast and overall an aesthetic, natural outcome.

In the “before and after” profile views, you can clearly see the change in the contour of the breast. Before surgery, the lower pole of her breast is flat. But after surgery, it has a nice curve. Prior to surgery, the upper pole of her breasts lack fullness, which is often a concern of many women who consult with me for breast revision surgery. By raising the fold, the implant can be pushed upward and improve fullness in the upper part of the breast.

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