Breast augmentation surgery is traditionally performed using implants in order to create fullness especially in the upper poles of the breasts, and increase the bust size in order to achieve a more womanly figure.
In some cases, the breast implants move downward as the tissue that supports the device becomes weak and lax. If this happens, the breast crease will settle lower on the chest, leading to a cosmetically displeasing result.
Fortunately, there are several ways to prevent this problem and one of the most effective is choosing the right implant size. For instance, petite women who often have a limited breast tissue and skin are generally recommended to choose smaller sizes in order to prevent bottoming out; in this way, they can also avoid visible and palpable ripples in the shell.
It is important to remember that inordinately large implants can expose patients to a higher risk of bottoming out and premature breast ptosis (or sagging) because of the extra weight the tissue and skin has to carry.
Another way to avoid bottoming out is creating an implant “pocket” which should be in the right size, preventing gross movements of the device. But in case that the room for implants has been over-dissected, the problem will usually occur just several weeks or months after a breast augmentation.
Meanwhile, the right placement of implant, particularly the complete submuscular technique, can also minimize the risk of bottoming out since the breast implants are supported by a thicker amount of tissue in the lower poles. This is not the case in other implant placements in which the lower poles are only supported by the skin tissue.
Another advantage of complete submuscular or “unders” is it prevents visible and palpable rippling because the top two-thirds of the implants is covered by the pectoral muscle.
Some doctors also suggest that using a bra that provides a good support to the weight of the implants can prevent or at least minimize the risk of bottoming out and breast ptosis.
But in case the implants have bottomed out, the only way to treat this problem is through another surgery which often involves an incision made along the breast crease. In this way, doctors can cut and roll up the tissue surrounding the device and then secure it with internal sutures.
Once the implant “pocket” has been corrected, the incision site is closed with tiny sutures.
For some patients, they may be asked to downsize their breast implants particularly if the main reason for bottoming out is the excess weight of the large implants.
