Cause: Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.

Bottoming out and Side Boobs Contributing Factors:

1. Larger/Heavier Implants
2. Implants placed above the pectoralis muscle
3. Chronically not wearing a bra when upright
4. Over dissection of the Implant Pocket
5. Smooth Implants
6. Large swings of weight including pregnancy
7. Skin and soft tissue laxity, loss of elasticity

Repair: Surgery is the only effective remedy. Revision surgery is almost always more complex than breast augmentation. Correction techniques vary based on your plastic surgeon’s experience and skill sets. Always choose a board certified plastic surgeon with expensive revision experience as even in the best of hands recurrence is frequent especially if larger implants are used. Repair techniques include some of the following techniques and recommendations:

1. Textured implants (“Velcro effect”)
2. Use of Smaller Implants
3. Maximum Submuscular Position (not just the pectoralis major but abdominis rectus below and serratus anterior on the side)
4. Capsulorrhaphy (tightening the pocket by sewing in-folded capsular tissue together)
5. Use of Biologic fabrics and other materials such as Acellular Dermal Matrix, “ADM” Alloderm, Strattice, “Silk” and others that can be used to reinforce the bottom of the pocket.
6. Change of position of implant to a new pocket location “neo pectoral pocket”
7. Internal Ryan Procedure (sutures binding the inferior mammary fold to stronger underlying tissues (e.g. fascial, periosteal)
8. Removal of Implants and replacement of volume using your own fat (Fat Transfer).

The procedure is performed under general anesthesia on an outpatient basis most often using an existing scar or making an incision beneath the breast. Recovery is similar to your original breast augmentation procedure. Use of taping after surgery and prolonged use of a support bra is often recommended. It is far more important to pick the best plastic surgeon rather than trying to pick the best procedure as they are in the best position to guide you to the right decision. See this article for help in selecting the best breast revision specialist.