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COVID-19 Reopening Updates View Update Virtual Consultation

A successful breast augmentation surgery not only relies on the skill of the surgeon but also the anatomy of the patient. Bottoming out is a complication that can occur either through an intentional or unintentional lowering of the breast crease or fold. A surgeon may need to intentionally lower the fold of the breast if a patient has a tight fold or if the patient is desiring a larger implant than their at anatomy will accommodate. In addition, this can happen if an implant is too large or too heavy for a patient’s skin elasticity. All of these scenarios result in an implant dropping lower on the chest then what would be ideally desired. The weight of the implant or trauma from surgery contributes to the overall final result.

As a consequence, a patient may see the implant slowly descending on the chest or the nipple appears to be higher on the implant than what it was originally. This appearance will often prompt patients to seek out professional help to correct the changes that have occurred. Fortunately, there are a number of different surgical techniques to help correct bottoming out of a saline or silicone breast implants.

Correcting the inciting cause is the primary goal of the surgery. If the implant is deemed to be too large then often we will recommend downsizing the implant. If it appears it was related to a surgical technique, then often the same implant can be kept in place. An in-person consultation would need to be completed to determine which of these were the primary cause.

The primary correction of this problem is what is been termed an “internal bra” technique. This involved suturing the breast capsule that normally develops after the placement of an implant. The capsule is a strong fibrous structure that can serve to support the weight of the implant. Frequently, this is all that is needed to do to correct the bottoming out. Often the capsule is simultaneously released in the upper aspect to facilitate the ease of movement of the implant in an upward direction. This can be done from side to side as well.

Another potential issue related to bottoming out is a phenomenon called a “double bubble”. This happens when the implant drops below the fold but the crease of the breast creates a second crease in the implant. This forms an indention in the lower aspect of the breast creating two bulges – commonly termed a “double bubble.” This too can be corrected through the process of tightening the internal capsule to its original, desired location.

There are additional, more aggressive options that exist to correct situations where the patient has had a reoccurrence of this problem or they are known to have a particularly weak capsule. In these situations, we commonly employ something called in an acellular dermal matrix (ADM) which is a collagen sheet that can be inserted into the body to help support the lower aspect of the breast. This can be used in all areas of the breast capsule the most commonly seen in a bottoming out type situation. We will discuss this more in an upcoming blog post.

If you are interested in learning more about your options for correcting bottoming out, call our office to schedule your complimentary, in-person consultation at 858-638-9800.

*The content in this blog is developed to spread the awareness towards plastic surgery. Our blog is not intended to serve as a replacement for an actual in-office consultation with Dr. Marin. As such, the information within this blog reflects the unique cases of our individual patients.

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In light of the state wide restrictions on non-essential businesses to help reduce the spread of COVID-19, we are rescheduling all of our elective appointments until the global circumstances improve. Our necessary post-operative appointments will be made, as needed, to address immediate surgical concerns such as suture removal and acute postoperative issues. All non-acute follow up appointments, fillers and Botox will need to be postponed until after the quarantine period mid April. Our office will reach out to all patients who need to be rescheduled.

We will be offering new patient virtual consultations online and via Skype that can be scheduled through our website or by emailing Also, we will offer follow-up appointments in the same manner to help manage our patients’ concerns while still respecting the need for social distancing.

We appreciate all of your understanding during these difficult times for all of us.

Stay safe,

Dr. Main and the Marin Aesthetics Team