Bottoming Out

“Bottoming Out” of breast implants is when the breast implant descends too low in relation to the chest wall, and the nipple appears too high in relation to the breast implant. It is mainly seen in very thin patients with essentially no breast tissue and minimal skin coverage. It is more common with breast implants placed above the muscle. It can be caused initially by over dissection of the implant pocket or by setting the new inframammary crease too low at the initial operation. However, in an experienced plastic surgeons hands, it is usually caused initially by a larger breast implant over stretching the skin and creating a pocket under the breast implant which the implant slides into. If it occurs later, it is usually the result of the weight from a larger breast implant i.e. greater than 400cc. It is not a function of the type of incision used to place the implants. It is seen with breast implants placed through transaxillary (armpit), periareola, and inframammary incisions. It can occur with all types of breast implants including smooth or textured, saline or gel, and round or tear drop.

The correction of this type of deformity is to dissect the capsule over the breast implant down to the chest inferiorly. This is best accomplished through an inframammary incision due to the optimal visualization this gives. It can be done through a periareola or an armpit incision, but this is extremely difficult and may require the use of an endoscopic camera system. The site of the new elevated inframammary breast crease is selected preoperatively, and the inferior capsule is ‘rolled’ upon itself to close the pocket up to the point of the new fold. This closes the breast implant space, and after suturing doesn’t allow the breast implant to descend. This is all accomplished through the 1.25 inch inframammary incision. Other sutures are placed as needed to close any areas of the pocket. The capsule is also released superiorly so when the breast implant is replaced it has room above and is not compressed inferiorly. The capsule is then closed to itself after replacing the breast implant. The skin can then be closed to itself as well as to the underlying fascia if an added layer of stability is needed. This is one of the more complex breast implant deformities to correct.

CareCredit Richmond Virginia DeConti Plastic Surgery
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