Bottoming Out

Bottoming out is a postoperative complication most commonly seen after breast augmentation. It occurs when the breast implant shifts downward so the implant sits below the original inframammary fold (the crease beneath the breast), producing a stretched lower pole, reduced upper pole fullness, and the appearance of the nipple sitting higher on the breast mound. Contributing factors include oversized implants relative to tissue support, weak or thin breast skin and soft tissue, inadequate pocket support or surgical technique, early or prolonged pressure on the lower pole, and natural tissue laxity over time.

Symptoms often develop months to years after the initial surgery and may include visible implant displacement, asymmetry, discomfort, or dissatisfaction with breast shape. Treatment typically involves surgical revision to recreate or reinforce the inframammary fold and reposition the implant; procedures can include capsulorrhaphy (tightening the implant pocket), switching implant size or type, adding internal sutures or mesh for support, or combining the revision with a mastopexy (breast uplift) to reshape and secure the breast tissue. Discussing risks, prevention strategies, and realistic expectations with a qualified surgeon can help reduce the likelihood of bottoming out and guide appropriate corrective choices if it occurs.