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          "Bottoming Out" of Breast Implants

          What happens when your breast implants go south of the border?

          "Bottoming Out" occurs when a breast implant(s) slips below the natural, or surgically lowered, inframammary crease (the fold line just under your breasts where they meet your chest).

          Have Your Implants Crossed the Line?

          Symptoms will include a lower breast crease. What's more, the nipple and areola complex may tilt upward as the breast implant heads south. Also, any inframammary scars from your breast augmentation may travel up the lower breast mound.

          Bottoming Out: Are You at Risk?

          You may be at risk for bottoming out if there was an over-dissection of the implant pocket(s) during your surgery. During breast augmentation, your surgeon creates a pocket within your breast where the implant will be placed. If the pocket is too big, it is known as an over-dissection.

          Bottoming out can also occur if your implant is too big and heavy for the amount of skin and underlying breast tissue.

          Implant placement also may play a role. If your implants are placed fully underneath your chest muscle, there is a much lower risk that they will bottom out than if they are placed above the muscle or partially below muscle. That said, placing breast implants fully under the muscle is the least common method of implant placement. It limits implant size and results in a more arduous recovery.

          Revision Surgery for Bottoming Out

          Bottoming out, or other post-surgical problems like double bubble breast augmentation, will likely require a revision surgery or procedure. There are several options based on the extent and cause of the problem.

          Your surgeon can sew the capsule under the breast in order to push the implant higher in the pocket and center the nipple and areola on the breast mound. This can be done using sutures or via a flap of tissue from the inside of the implant pocket. This is not ideal, as the stitches can cause scarring.

          Another option is to use tissue substitutes such as Alloderm or Strattice to hold the breast up and support the implant. These products can be used to create a structural brace for women who do not have enough tissue of their own.

          In some cases of bottoming out, a breast lift (mastopexy), with possible removal of skin along the inframammary fold, may be needed.

          If the bottoming out occurred because your breast implants were too heavy and big for your frame, it could become a chronic problem, unless you downsize.

          If you are concerned about bottoming out, ask your board-certified plastic surgeon if you are at risk, and what steps can be taken to minimize your risk.

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            Joseph A. Mele, MD, FACS

            130 La Casa Via
            Building 2, Suite 206
            Walnut Creek, CA 94598
            (925) 943-6353
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          • 95 Scripps Drive
            Sacramento, CA 95825
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            Charles Lee, MD

            Enhance Medical Center
            462 N Linden Dr
            Beverly Hills, CA 90212
            (877) 868-1772
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