“Bottoming out” describes the condition of a breast that is bottom heavy.The breast implant should be the target and the nipple-areolar complex should be the bull’s eye- or slightly above the mid-point. Bottoming out occurs when this balance is altered, with the breast implant lower and thus the nipple-areolar complex appears high.
While the causes of bottoming out are many, some of the more common are:
- the breast implant stretches out the tissue below the nipple-areolar complex.
- poor quality skin which stretches easily.
- a surgeon dissecting the lower breast pocket too low during placement of the breast implant.
- when the breast implant is placed concurrently with a breast lift procedure (mastopexy), over time, the skin can stretch.
Treatment of bottoming out is to re-establish the bottom support of the breast. This requires breast revision surgery. The skin must be sutured down and upward so that the distance between the nipple-areolar complex and the breast fold is reduced to the appropriate length. This will hold up the breast implant to the proper position, creating a better relationship to the nipple-areolar complex. A variety of suture techniques exist to hold the implant in position.
Bottoming out of the breast means a troublesome breast deformity. Breast revision surgery requires a surgeon with in-depth knowledge and extensive experience to successfully improve the deformity.