Implants drop low and nipples appear higher.
After breast augmentation, most patients can’t wait to see the result after the “drop and fluff” stage, which is the lovely moment when high and tight breast implants settle into a beautiful, natural look. But sometimes, gravity acts too harshly. One administrative problem known as bottoming out is when the implant slips beyond the natural breast fold, going lower on the chest wall than planned.
We’re totally aware of the stress this can bring at Lin Europe Clinic. You might be starring at yourself in the mirror and questioning if this is just normal settling or if something different might have happened. Bottoming out is not just a matter of aesthetics; it is a breakdown of the mechanical function of the internal pocket. A healthy drop from an implant that has been displaced is the very first step after which you can think of different solutions.
Recognizing the Visual Signs
Without a doubt, the best way to check for bottoming out is to look at how your nipple and the implant relate to each other geometrically. Ideally, the position of the nipple on the breast should be somewhere near the middle or even just a bit below the middle of the breast mound. When the implant bottoms out, the volume moves downward, however, the nipple is still where the skin is and the skin with which the nipple was originally connected did not move. So the nipple looks “high-riding” and that is why it seems too high on the breast; in fact, it is often seen as pointing towards the ceiling.
Another noticeable line that separates your breast plastic surgeon’s expectations from your reality is the proportion of the breast, especially the upper pole. Generally, to achieve the “Golden Ratio,” plastic surgeons want around 45% of the breast volume to be above the nipple and the rest (55%) below it to get a gentle slope. Bottoming out ruins this ratio completely, thus the area between your collarbone and your nipple seems excessively flat, long, or empty. In very bad cases, the visual impression is often compared to “a tube sock with a heavy ball in the toe,” in which the skin above the nipple seems to be too stretched and as if it is going to break while all the mass and weight of the implant have fallen down and gathered at the very bottom.
Why Does It Happen?
Bottoming out basically happens when the weight of the implant is too much for the tissue support to handle. An instance can also be a surgical mistake known as over-dissection whereby the surgeon gave too much of the tissue during the initial surgery or loosened too much the muscle attachments, thus disrupting the internal shelf that held the implant. Nevertheless, it very often happens because the tissue itself is weak.
In some patients, due to their genetics, significant weight loss, breastfeeding, or smoking, their skin might be so poor in elasticity that the connective tissue is not able to resist the gravity of a heavy implant. And of course, the laws of physics have something to say too. For instance, very large, high-profile implants place a lot more downward pressure than smaller ones. Hence, over time, a 500cc implant will probably manage to push the pocket open far more than a 250cc one. Also, there is the issue of the breast stabilizer band being misused; thus if a patient wears the band too tightly or for too long even after the implants have already dropped, in this way, they may inadvertently end up pushing the implants beyond the right point.
Prevention During Recovery
It is acknowledged that you cannot change your genetics but what you can do is reduce the risk factors during the recovery period by, among other things, strictly adhering to the bra protocol. The right provision of the surgical bra allows you to get the proper supply of upward support while at the same time, the internal capsule is being formed. A common mistake that people make is to overuse the stabilizer band, so one should be very careful to discontinue the use of the stabilizer band right away when the surgeon tells so. Additionally, you should not do any high-impact activities such as jumping or running without a high-support sports bra during the first couple of months as such activities give the implants unnecessary G-force and also put a strain on the healing lower pocket.
Surgical Solutions: The “Internal Bra”
After a point, however, even the best chest exercises or firm bras won’t be able to fix one’s bottoming out. It is a structural problem caused by the stretching of the internal pocket; thus it has to be fixed surgically. Capsulorrhaphy is the main method of treatment during which the surgeon places permanent internal stitches to close the bottom of the pocket, thus pushing the floor upwards. Cases get more complicated when tissue is weak, and in such a situation, the patient might even get a recurrence if only stitches are applied, without any kind of reinforcement because of the cheese-wire effect.
Therefore, at such a time, we resort to the use of bio-absorbable mesh, such as Galaflex or dermal matrix, to make an internal bra. We do the surgical implantation of this mesh in such a way that a hammock or sling is created underneath the implant thereby giving reinforcement not only to the bottom of the pocket but also acting as a seatbelt for the implant which physically prevents it from slipping down once again.
Revision Surgery in Turkey
Before changing a bottomed-out implant, a surgeon who knows the basics of architectural reconstruction thoroughly is required. It is much more involved than a primary augmentation because after all, the tissue has been used. At Lin Europe Clinic in Istanbul, we have the experience of focusing on these delicate revision cases. We don’t just elevate the implant; we give extra support to your body so that the results don’t disappear very soon. Our “one-stop-shopping” service guarantees that you get the proper pre-surgery diagnostic imaging to precisely identify the repair site. We welcome you to come to Istanbul where, apart from surgical accuracy, we also blend our internal support techniques in repairing your body proportions.
Frequently Asked Questions About Bottoming Out
The major symptoms are nipples that point upward (high-riding), the distance from the nipple to the bottom of the breast being excessively long, and a flat upper chest.
Unfortunately, no. It is basically a structural problem that the pocket has been internally stretched. No amount of exercise, taping, or wearing different bras will be able to firm up the internal tissues; only surgery is the answer.
Not necessarily. If the pocket was over-dissected, it may occur within the first few months. Otherwise, it may take years after the effects of gravity, weight changes, and tissue aging.
Yes, the breast stabilizer band if worn too tightly, or even for a long time after the implants have already fallen, can result in your forcing them too low.
The recovery is, in fact, generally less difficult than the original operation since the muscle is not made to stretch, however, the support bra that you have to wear to the letter, in order to protect the repair, will still be a necessity.
Bengtson, B. P. (2011). Complications, adverse events, and reoperations in breast augmentation. Clinics in Plastic Surgery, 38(3), 321-334.
Maxwell, G. P., & Gabriel, A. (2014). Bio-dimensional planning in revision breast augmentation. Clinics in Plastic Surgery, 41(4), 505-512.
Spear, S. L., & Rottman, S. J. (2016). The correction of breast implant complications. Plastic and Reconstructive Surgery, 137(3), 856-867.
Stevens, W. G. (2010). Revision Breast Surgery. Thieme.
