If you want your breasts to look prominent and perky, a breast implant procedure can make this possible. The surgery involves the use of prosthetic devices called implants to enhance your breast size and shape. However, there are a number of potential complications associated with the procedure, and one such problem is the bottoming out of breast implants. The breasts bottom out when the surgeon places the implants very low inside your breasts, to the point that the implants fall lower than the inherent lowest fold of the breasts. Several factors can trigger bottoming out, including overcutting the implant pocket, large implants, low implant positioning, poor skin quality, and drastic weight fluctuation. Bottoming out of the breasts after an implant surgery can be addressed by undergoing a breast revision procedure, which may include the formation of a new implant pocket, removal and replacement of the implant, mesh sling, dermis graft, and capsulorrhaphy. What is Bottoming Out? While undergoing an implant surgery can substantially enhance the breasts in terms of size and shape, the risk of the breasts bottoming out is present. This condition occurs when the implants are situated very low on the chest that they plummet even lower than the inherent lower fold of the breasts. In some situations, this can even lead to the creation of a double bottom fold. Some patients may even get breasts with the nipples standing abnormally tall on the breast mounds. This can make the nipples point out piercingly. What Causes Bottoming Out? Bottoming out of the breasts is mostly caused by the lack of inner sustenance for the breast implants. It is important to understand that when you get breast implants, the skin alone is not enough to support them and keep them in place and position. The chest muscles also must provide support to the implants, in addition to the ligaments and tissue. In case of lack of sufficient support, the breast implants will slope downwards as a result of the force of gravity. Bottoming out can also be caused by other factors, including the following: Over-separation of the pockets: If your plastic surgeon is inexperienced or unskilled, he or she may end up over-separating the implant pocket. This can cause bottoming out of the breasts right after the procedure. Getting very large implants: Very large breast implants can also cause bottoming out of the breasts. The weight of large implants exerts pressure on the skin, muscles, ligaments, and tissues. This can cause the implant to migrate downwards due to the gravitational force. Extremely low placement of the implants: Again, this condition can occur if your plastic surgeon is inexperienced or unskilled. He or she may place the breast implants extremely low on your chest wall, which can trigger bottoming out of the breasts. Weight fluctuations and pregnancy: Drastic changes in your weight and pregnancy have been found to be among the leading causes of bottoming out of the breasts after the breast augmentation surgery. This happens because your muscles lack enough strength to support the additional weight of your breasts. How To Fix Bottoming Out Bottoming out of the breasts after getting implants can be upsetting for the patient. However, this condition can be corrected via a revision surgery. There are a number of surgical procedures to increase support for the breast implants, which can in turn fix the bottoming out. These procedures are: Capsulorrhaphy: This is one of the most common and effective treatment options for breast implants bottoming out. This operation increases the implant case to boost strength and form additional support for the migrated implants. This procedure can be performed only by highly experienced plastic surgeons due to the complexity of the process. Implant pockets have a tendency to become reedy, making it hard for the surgeon to enhance support for the implants. There is also a possibility that your existing breast implants may be removed and replaced with newer, smaller ones to treat the bottoming out. This would necessitate reconstruction of the implant pocket as well. Creation of new implant pocket: In case the breast implants are positioned above the breast muscle, your surgeon can simply fix the bottoming out by forming a new implant pocket underneath the breast muscle. Placement of the implants underneath the muscles can deliver more tissue coverage to the implants. Dermis graft: There are many plastic surgeons who use the dermis graft technique to treat bottoming out of the breasts. This approach creates an inner bra by using Alloderm to resolve the problem. The inner bra surrounds the tissue and delivers support to the implants. Mesh sling: This is yet another effective treatment option for the bottoming out of the breasts. This technique is mostly used where the patient lacks sufficient tissue to deliver support to the breast implants. The mesh sling also forms a frame to cover the tissue, so it can grow and provide support to the breast implants. Implant removal and replacement: If the bottoming out is occurring as a result of very large implants, your surgeon will perform an explant surgery to remove the large implant and replace it with a more ideally sized one. Conclusion Bottoming out of the breasts is one of the risks that come along with breast implant surgery. This condition occurs when the implants fall very low, even below the lower fold of the breast. This condition can happen any time after the breast augmentation procedure. Factors that contribute to bottoming out include over-separation of the breast implant pockets, the use of very large implants, very low positioning of the implants, and other surgical errors. This complication can be treated through revision surgery. Your plastic surgeon will be able to device a particular surgical technique to correct the bottoming out of your breasts after examining your chest.