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“Bottoming Out” – Breast Implants


bottoming out breast implants

Recurrent breast implant ptosis (or “bottoming out” of the implant pocket) is fortunately not common.  However, it does happen.

“Bottoming out” means that the breast implants have descended too low on the chest, thus making the nipple too high on the breast mound. If bottoming out is apparent shortly after surgery, it is most likely due to over-dissection of the pocket. If it occurs later on, it is usually due to the weight of the implant.

Bottoming out is usually seen in thin patients with very little breast tissue and skin coverage. It is more common with implants placed above the muscle, and is less common with implants placed in the total submusculofascial position (complete submuscular).  The type of implant used does not have any relation to bottoming out. It can occur with smooth, textured, saline, or silicone gel implants.

Traditionally, the surgeon would sew the implant capsule to the rib periosteum (the tough fascia covering the rib) at a level of the previous or desired inframammary fold using non-absorbable sutures.  Even with this technique, however, some patients developed recurrent ptosis.  In some cases, the quality of the capsule and the patients’ soft tissue strength are not strong enough to hold the weight of the implant. See below video for case study:

With the common use of allograft dermis (this is the dermal part of the skin which has been processed so it can be used in another person without developing an immune response) in breast reconstruction, it was a matter of time before this product found a niche in cosmetic breast surgery.  The allograft dermis can be used as a sling to give support to the implant.  This technique now is considered more desirable than breast capsule revision.  Unfortunately, the cost of the dermis is prohibitive for most patients, as the typical size used will cost $1000-2000.  This is in addition to cost of anesthesia/operating room and surgeon fee.  However, if one considers this technique will minimize the chance of recurrence even more than the traditional capsule revision, it can potentially save the patient additional surgery, which will result in less cost to the patient overall.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon in Santa Ana with over 13 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call (714) 834-0101.

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