If you’ve noticed your breast implants seem lower than before, especially without a bra, you might be experiencing what’s known as bottoming out.

Simply put, this occurs when your implants descend below your natural breast fold, causing an unnatural fullness toward the bottom of your breasts. You may also notice your nipples pointing slightly upward or feel concerned by the noticeably lengthened distance between your nipple and the breast crease.

This can absolutely be frustrating for patients, but as a plastic surgeon specializing in complex breast revisions, this problem is entirely fixable.

How the Breast Fold Connects to Bottoming Out

Every breast has a natural fold called the inframammary fold (IMF). I often describe it to patients as a built-in hammock that supports your breast implant and natural breast tissue.

When we perform breast augmentation surgery, this fold is one structure we must be particularly cautious about. Disrupting it can have lasting consequences.

During augmentation, the implant is carefully placed into a surgically created pocket. If this pocket is over-dissected or made larger than necessary, the fold can weaken, allowing implants to shift downward over time.

This is why surgical precision is so vital, especially around the fold, because once it’s compromised, it can be difficult to restore.

Why Bottoming Out Happens

Bottoming out is typically due to factors related to surgical technique or tissue support.

In my practice, these are the most common causes I encounter:

  1. Over-dissection during surgery: If the surgeon overly disrupts or weakens the inframammary fold while creating the implant pocket, the natural support can be lost, making it easier for implants to shift downward. This structural integrity is something I emphasize strongly during every breast augmentation procedure because it’s crucial for long-term stability.
  2. Choosing implants that are too large: Selecting implant volumes too large for your tissues to comfortably support is another significant factor. Heavy implants naturally exert more gravitational force, gradually pushing down and eventually compromising the fold. It’s important to align implant size with your individual anatomy to ensure lasting results.
  3. Skin and tissue laxity: Pregnancy, weight fluctuations, aging, and genetics can all affect skin elasticity. If your tissues become lax, the support structure around the implant weakens, increasing the risk of bottoming out over time.
  4. Lifestyle factors: Intense physical activity, not following your surgeon’s post operative restrictions, or not consistently wearing supportive bras post-surgery can further strain tissues during the critical healing phase, exacerbating the risk of implant displacement.

How to Tell If Your Implants Are Bottoming Out

It can be tricky to determine if your implants are truly bottoming out.You can often begin at home with a simple mirror check. Here’s how:

  • Visual inspection: Stand straight, braless, and observe whether your implant sits noticeably below your natural breast crease.
  • Nipple position check: Notice if your nipples seem unusually high or pointing upward.
  • Distance measurement: Measure the distance from your nipple to the breast fold. A visibly elongated distance compared to earlier months or years can indicate bottoming out.

Remember that a definitive diagnosis requires a professional evaluation even after a home assessment.

In my office, I conduct a thorough physical exam, often accompanied by precise measurements or imaging. This helps clearly distinguish bottoming out from similar issues like the double-bubble deformity.

Accurate diagnosis allows me to grade severity and map out the best corrective plan tailored to your anatomy and cosmetic goals.

How We Fix Breast Implants Bottoming Out

As a surgeon focused on personalized solutions, my approach to repairing bottomed-out implants varies depending on your specific anatomy and goals.

Here are the most common, effective methods:

Capsulorrhaphy (Pocket Tightening)

This technique involves stitching the internal capsule (the natural scar tissue around your implant) to elevate the implant pocket.

By surgically tightening and reshaping the lower capsule, I recreate your breast’s natural fold at the appropriate position, helping secure the implant higher and restoring a balanced appearance.

Internal Bra Mesh (Reinforcement)

For added support, I frequently use an internal bra mesh. Think of this mesh as a hammock placed beneath the implant, gently holding it in place.

During surgery, after removing or repositioning your implant, I carefully secure this absorbable mesh along your chest wall to reinforce and stabilize the implant pocket. 

Over several months, your body naturally replaces this mesh with your own supportive collagen tissue, providing long-lasting results. In my experience, internal bra techniques significantly reduce the risk of future displacement, especially in cases where tissue quality is compromised.

Implant Exchange & Downsizing

If your current implants are too heavy or oversized for your tissues, exchanging them for smaller implants can be beneficial.

A more proportional implant places less gravitational stress on your breast fold, helping to ensure your results remain stable and aesthetically pleasing for years to come.

Recovery for Bottomed-Out Implants

Recovery from revision surgery for bottoming out is typically straightforward, and my patients often find the experience smoother than anticipated.

Here’s a general timeline to guide your expectations:

  • Week 1: Mild soreness and swelling; You’ll wear a specialized support bra to maintain the implant position and ease discomfort.
  • Weeks 2 to 4: Gradually return to daily activities; continue wearing your supportive bra full-time. No heavy lifting or intense workouts.
  • Weeks 4 to 6: Most swelling resolves. You may return to gentle exercise, but continue wearing a supportive bra daily.
  • Beyond 6 Weeks: Resume normal activities, keeping in mind ongoing bra support for the first 3 months after bottoming out repair is helpful to ensure long-term stability.
  • When modern surgical methods (like internal bra mesh reinforcement) are properly applied, recurrence rates for bottoming out are typically under 10%.

Costs and Insurance for Revision Surgery

It’s important to know upfront that revision surgery for bottoming out is typically elective and not covered by insurance, as insurers usually consider this a cosmetic procedure. 

Costs can vary depending on factors such as:

  • The complexity of your case
  • The use of reinforcement materials (mesh)
  • Whether implant exchange is involved

In general, revisions may cost slightly more than a primary augmentation due to additional surgical complexity.

How to Choose a Surgeon for Revision Surgery

When seeking a surgeon to address bottoming out, I recommend the following checklist:

  • Board certification: Choose a plastic surgeon certified by the American Board of Plastic Surgery.
  • Experience: Ensure your surgeon specializes in complex breast revisions, not just primary augmentations.
  • Before-and-after portfolio: Review actual patient results specifically for bottoming-out repairs.
  • Consultation comfort: Trust your instincts; choose a surgeon who you feel genuinely listens and clearly explains your options.

Bottoming out can feel distressing when you first notice changes in your appearance, but remember, it’s both common and entirely fixable.

Addressing the issue sooner rather than later makes the surgical correction easier, restores your confidence, and gives you results you’ll love again.

If you’re concerned that your implants might have bottomed out, I encourage scheduling a personalized fold-assessment consultation at our Richmond office. Together, we’ll create a surgical plan tailored to restoring your shape, comfort, and peace of mind.