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Breast Implant Bottoming Out

What Is Bottoming Out?

"Bottoming Out" is a term which describes when a breast implant(s) slips below the natural, or surgically lowered, mammary crease. This can make the breast implant(s) displace to a level too low on the chest.

Symptoms

Symptoms will include a lower breast crease which is not intended. While some creases are lowered intentionally when a significant size change is requested, if the tissue is over-dissected the crease may continue to descend on the chest wall. The nipple and areola complex may tilt upwards as the implant is displaced to the lower pole of the breast. Also, you may notice if you had infra-mammary scars that they are riding up the lower breast mound.

What Are The Causes of Bottoming Out?

Causes can be physical factors of the patient, or it can be surgeon error, or a combination of both. It is most often seen in patients who are very thin, have thin skin and who had very little breast tissue or breast envelope prior to their surgery. It can happen in persons who have poor skin elasticity and connective tissue disorders. It can also happen when a surgeon over-dissects the pocket and causes weakening of the connective tissue at the natural mammary crease. This along with added weight of the mammary prosthesis (breast implant) can cause a slow, or immediately apparent, descent of the prosthesis. A significantly large implant can also cause bottoming out over time from constant pressure exerted to the mammary crease by the prosthesis.

It is least often seen in patients who have full sub-muscular implant placement as the fascia of the abdominus rectus and serratus muscles assist in supporting the weight of the implant, thereby reducing the pressure applied to the fibrous tissue at the mammary crease.

Corrective Surgery

While correction is possible it can be difficult. During surgery, the breast implant is often removed, the capsule (if applicable) is released and rolled to create a barrier at the proper mammary crease height. Some surgeons use only internal, resorbable sutures, others permanent sutures such as Mersilene, a polyethylene braid, and even other removable or resorbable percutaneous sutures. The only problem with percutaneous sutures is the obvious, multiple scars. However, the infra-mammary scar for implantation is not exactly invisible to begin with. Patients who do not have significant tissue for scaffolding support can use AlloDerm cadaveric dermis graaft rolled and sutured in place.

In patients with multiple corrective surgery failures, your surgeon may feel the need to temporarily leave the implant(s) out and wait for proper healing and scar tissue formation to occur. Then and only then will he feel it is safe to re-implant. This way, less pressure is exerted on the newly revised crease, and strengthening of this area can occur without strain.

Recovery

You will be asked to wear a supportive garment and possibly a breast wrap or bandeau underneath the breasts to both increase pressure on the newly adhering tissues and to keep the tissue from naturally dissecting under the weight of the natural breast and/or the breast implant if left in place.

The scars will usually fade to some degree in the average patient. For many, these scars will start out as light pink, then turn a darker red and then after 3 months post-op they will begin to slowly hypopigment due to the lack of melanin in scar tissue. If the remaining usually thin, light colored scars bother you, you can always get micropigmentation to restore a natural looking "pigment" to the area which is the implantation, or tattooing, of the scar with flesh-toned ink.

Rate of Successful Correction

While no independent, widely documented studies have taken place in regards to displaced implants due to bottoming out, the success rates tend to be better in persons with smaller breast implants, therefore less weight on the newly adhered tissue. Surgeon experience and skill with this particular problem is also relevant to the success rate of your revision surgery. Also, please realize that wearing a support bra will be essential for many months to help increase your chances of a successful correction.