[ARTICLE] ‘Bottoming Out’ After Breast Surgery: Diagnosis and Management Should Be Led by the Primary Surgeon

Concerns over “bottoming out” are rising among individuals who are considering breast augmentation or have already undergone the procedure. Bottoming out refers to a condition where the breast implant slips below the intended inframammary fold, eliminating the natural distance between the nipple and the breast crease. This can lead to the appearance of a double fold or cause the nipples to tilt upward at an unnatural angle, posing not only aesthetic issues but often requiring revision surgery as well.

Dr. Soonbeom Kwon, Director of ARC Plastic Surgery, explained, “Bottoming out typically occurs when the implant is not properly secured. This is often the result of using an implant that is too large for the patient’s anatomy or creating an excessively wide or imprecise surgical pocket during the procedure.” He added that patients with thin skin or insufficient tissue to support the implant are also at risk of this complication. When bottoming out occurs, the implant may shift and become asymmetric, or the breast shape may collapse, making revision surgery inevitable.

To enhance surgical outcomes, it is crucial to focus less on postoperative device-based care and more on accurate diagnosis and close monitoring by the primary surgeon. While equipment like radiofrequency or ultrasound devices are often used after surgery to reduce swelling or prevent capsular contracture, these should be applied selectively and only at the appropriate time under the surgeon’s guidance. Overuse of such devices may excessively soften the tissue, increasing the risk of implant displacement and bottoming out.

Similarly, laser treatments or injections for scar improvement must be administered only after a physician’s direct examination to be truly effective.

Dr. Kwon emphasized, “What matters most is not just how the patient is managed postoperatively, but how precisely the surgery is performed and how meticulously the surgeon monitors the patient’s recovery and responds accordingly.” He advised choosing a clinic where the primary surgeon personally oversees the patient’s care and provides appropriate treatments when necessary, as this greatly enhances the overall results and reduces the likelihood of complications.

By Seongwoo Cho | Medical Today