Bottoming out, or inferior breast implant displacement, occurs when one or both implants descend too low on the chest wall. Often the implant is below the natural inframammary fold. The implant appears too low and the volume of the implant is localized in the lower half of the breast. It also causes the nipple position to appear much higher than is proportionate to the rest of the breast.
Why implants bottom out
Implants tend to bottom out with large breast implants of 500cc's or more, as well as with implants that are placed over or only partially under the pectoral muscle. Bottoming out is also more likely to occur in thinner patients with less natural breast skin and tissue. The skin in the lower half of the breast becomes stretched out and the implant descends.
Over-dissection in the region of the inframammary crease (breast fold) during breast augmentation surgery may also cause implants to bottom out.
Correction of bottoming out implants
In order to correct bottoming out implants, the inframammary crease must be re-created in a higher position by cutting and rolling up the tissue surrounding the implants. The tissue is held in its new position with internal sutures, which also keep the implants in the proper position. Acellular dermal matrix may be used to suppor the repair. Patients with overly large implants are encouraged to down-size their implants. Saline implants, which are heavier than silicone, may be exchanged to silicone implants.