What is “Bottoming Out” after breast augmentation?

It is common for your new breast implants to sit slightly high right after a breast augmentation. Over the next few months, the implants will drop into a normal position. Some refer to this process as “fluffing”. But what if your breast implants continue to drop, to an abnormal position? This is referred to as “bottoming out” and is a bad (but too common) complication of a breast augmentation.

If a breast implant “bottoms out”, it drops below the normal breast fold. This causes the nipple to turn upward and appear near the top of the breast mound instead of over the center. Also, as the breast implant drops lower, the upper pole of the breast becomes flatter.

The cause of this is usually over aggressive dissection of the breast fold. If the surgeon disrupts the support structures of the normal breast fold, the fold weakens and cannot support the weight of the breast implant. Large and heavy breast implants may make this problem more likely.

Repair of this problem involves reconstructing the breast fold. This can be done with carefully placed internal sutures. Recently, surgeons are now using acellular dermis – either human or pig dermis – to help strengthen these internal sutures and to help support the breast implant in the normal position and prevent it from sliding lower. Keep in mind that these materials provide great results and are recommended, but it can add about $2,000 to the cost of your surgery.

“Bottoming Out” is unfortunately common with breast implants and while we have very good and effective ways of repairing it, it is best not to suffer from this at all. Like everything, the key is prevention. Your surgeon must respect the fold. The breast fold is a normal anatomic structure and care must be taken to not damage it during a breast augmentation. I should mention that it is standard to have to slightly lower the fold to accommodate breast implants, but this needs to be done carefully. Also, very large implants in very thin women should be avoided because of this possible complication.

To learn more about Dr. Schulman and his breast augmentation or to schedule your consultation, contact us or call 212-289-1851.

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