Breast augmentation is a transformative procedure that has helped countless women achieve the aesthetic silhouette they desire. However, as with any surgery, complications can arise, and one of the most common concerns faced by patients after breast augmentation is a phenomenon known as “bottoming out.” While the term may sound daunting, understanding the causes, identifying the symptoms, and exploring the solutions can provide clarity and peace of mind.

What is Bottoming Out?
Bottoming out occurs when a breast implant shifts downward beyond its intended position, causing an unnatural elongation of the breast. This condition results from the weakening or stretching of the lower portion of the breast tissue or the breast pocket that holds the implant. Instead of maintaining a balanced, full look, the implant droops, creating an uneven appearance where the nipple is positioned higher on the breast mound than intended.

In essence, bottoming out disrupts the harmony of the breast’s proportions, making it a significant concern for women who have undergone breast augmentation with the hope of achieving a specific, refined look.

Recognizing the Symptoms
Identifying bottoming out early can be crucial for a timely and effective solution. Here are the most common signs:

• Nipple Displacement: One of the hallmark signs of bottoming out is the nipple appearing unnaturally high on the breast, almost as if it’s pointing upward.
• Overstretched Lower Breast: The lower pole (bottom half) of the breast may appear elongated or droopy as the implant slips downward.
• Loss of Upper Fullness: As the implant shifts down, the upper portion of the breast may lose its fullness, resulting in a flatter appearance on top.
• Asymmetry: Bottoming out often affects one breast more than the other, leading to asymmetry in size and shape.

If any of these symptoms present themselves, it’s essential to consult with your surgeon to determine if bottoming out is the cause and to explore the available corrective options.

Causes of Bottoming Out
Several factors can contribute to bottoming out, ranging from anatomical considerations to post-surgical complications. Understanding these causes can help in both prevention and treatment.

1. Implant Size and Weight: Larger, heavier implants can exert more force on the breast tissue and skin, making it more likely for the implant to slip downward over time. While larger implants may provide the desired volume, they also demand stronger tissue support.
2. Weak or Thin Tissue: Women with naturally thin or weak breast tissue are more susceptible to bottoming out. The tissue may not have enough strength to hold the implant in place, leading to premature sagging or stretching.
3. Surgical Technique: A skilled surgeon will carefully create a pocket for the implant that supports its placement. However, if the pocket is too large or positioned too low on the chest wall, the implant may not be properly supported, increasing the risk of bottoming out.
4. Over-Dissection of the Breast Pocket: When too much tissue is dissected during surgery to create the pocket, it can reduce the amount of support for the implant. This can make it easier for the implant to shift downward over time.
5. Gravity and Time: Gravity is a natural force that affects us all, and over time, even well-placed implants can begin to descend, especially if the skin and tissue lack elasticity.
6. Post-Operative Activity: Engaging in strenuous physical activity too soon after surgery can strain the breast tissue and pocket, leading to bottoming out. Following post-operative care instructions is crucial in preventing such complications.

Solutions for Bottoming Out
While bottoming out can be a frustrating complication, it is by no means irreversible. Several effective solutions are available, depending on the severity of the condition and individual patient circumstances. Here are some of the most common corrective techniques:

1. Internal Bra Technique:
   Dr. Don R. Revis, JR., MD, FACS, has pioneered one of the most advanced solutions for bottoming out—The Original Internal Bra. In this innovative procedure, additional internal support is created using biologic or synthetic materials. These materials act as an “internal bra,” holding the implant in place and reinforcing the weakened tissue or breast pocket. This technique provides lasting results, helping to prevent future complications like bottoming out while maintaining a natural, aesthetically pleasing appearance.
2. Capsulorrhaphy:
   Capsulorrhaphy involves surgically tightening the breast pocket where the implant sits. By reinforcing the lower breast tissue or stitching the internal layers, the surgeon can reposition the implant and prevent further downward movement. This technique often works well for women who experience moderate bottoming out.
3. Revision Surgery:
   For more severe cases of bottoming out, a revision surgery may be required. This can involve repositioning the implant, adjusting the size of the implant pocket, or even selecting a different type of implant. In some cases, a smaller implant may be recommended to reduce the strain on the tissue.
4. Submuscular Placement:
   If the original implant was placed above the muscle (subglandular placement), a revision surgery may involve placing the implant below the muscle (submuscular placement). The pectoral muscle provides additional support for the implant, reducing the risk of bottoming out.
5. Tissue Grafts or Mesh:
   In cases where the breast tissue is too weak to support the implant, a surgical mesh or acellular dermal matrix (ADM) may be used. These materials act as scaffolding, providing additional support for the implant and reducing the likelihood of bottoming out in the future.

Preventing Bottoming Out
As with any surgery, the best approach is always prevention. While some factors like tissue strength and gravity are beyond our control, there are several steps women can take to minimize the risk of bottoming out:

• Choose the Right Surgeon:
  Select a board-certified plastic surgeon with extensive experience in breast augmentation and implant revisions. A skilled surgeon like Dr. Revis will take into account your anatomy, implant size, and placement to reduce the risk of complications.
• Follow Post-Operative Instructions:
  Adhering to your surgeon’s post-operative care instructions is crucial in preventing bottoming out. Avoiding heavy lifting and strenuous activities during the healing period can make a significant difference.
• Regular Follow-Ups:
  Post-operative check-ups allow your surgeon to monitor the position of your implants and catch any signs of bottoming out early.

Meet Dr. Don R. Revis, JR., MD, FACS – Creator of “The Original Internal Bra”
Dr. Don R. Revis, JR., MD, FACS, is a world-renowned plastic surgeon who has earned a reputation as one of the most skilled and innovative specialists in breast surgery. With years of expertise in breast augmentation, breast implant revision, and large breast augmentation procedures, Dr. Revis has become a trusted name for patients seeking superior outcomes and personalized care.

Dr. Revis’ dedication to enhancing his patients’ results and reducing post-surgical complications led him to create “The Original Internal Bra” technique. This groundbreaking procedure is designed to offer enhanced support to breast implants, particularly for patients dealing with complications like bottoming out, double bubble, or implant displacement. His innovative approach provides long-term results and has set a new standard for breast augmentation and revision surgeries worldwide.

Dr. Revis is not only recognized for his surgical skills but also for his compassionate approach to patient care. With over 300 first-time augmentations performed annually, he ensures that each patient receives a tailored treatment plan based on their unique anatomy and aesthetic goals.

As a board-certified plastic surgeon and fellow of the American College of Surgeons (FACS), Dr. Revis has dedicated his career to advancing breast surgery techniques while prioritizing patient safety and satisfaction. His extensive experience and ongoing commitment to excellence make him a leader in the field, offering both primary breast augmentations and complex revision surgeries for women from across the globe.

Discover Lasting Solutions with Dr. Revis
Bottoming out after breast augmentation, while concerning, is a manageable and often preventable complication. By understanding the causes, recognizing the symptoms, and seeking timely solutions, patients can maintain the beautiful, balanced results they desire. With Dr. Don R. Revis, JR., MD, FACS, and his innovative “Original Internal Bra” technique, women can rest assured that they are in expert hands.
Schedule your free virtual consultation today and discover how Dr. Revis can help you achieve the lasting results you’ve always envisioned.

Because your confidence deserves the best.