When implants slide below the natural breast fold, the results are unmistakable — nipples pointing upward, no lower pole support, and a shape that looks nothing like the original augmentation. Dr. Tachmes reconstructs the inframammary fold and restores natural breast position.
Submit Your Case for Dr. Tachmes' ReviewOr call Dr. Tachmes directly: 786-603-9074 — no coordinators.
The inframammary fold — the natural crease beneath your breast — is an anatomical boundary that holds the breast and implant in the correct position. When this structure weakens or fails after augmentation, the implant descends below that line. This is bottoming out.
The result is immediately visible: the bulk of the breast sits too low, the nipple-areola complex appears to point upward or forward rather than downward, and the upper pole of the breast looks disproportionately full while the lower pole loses definition. Clothing fits differently. Bras no longer support correctly. And the implant may become visible or palpable below the natural fold line.
Bottoming out is not a cosmetic preference issue — it is a structural failure that worsens over time. Without correction, continued weight-bearing on the stretched tissue accelerates the descent. The longer it goes untreated, the more tissue repair is required.
Dr. Tachmes has corrected hundreds of bottomed-out augmentations over his 32-year career as a breast revision specialist in Miami Beach.
The implant sits visibly lower than it did after your original surgery.
Your nipple appears too high on the breast mound — pointing upward rather than forward.
You can see or feel the implant below your natural breast crease.
The upper breast looks hollow or deflated while the lower pole is overfull.
Bras no longer fit or provide proper support.
The condition is getting worse, not better, over time.
Oversized implants relative to the available tissue envelope are the most common cause. Too much weight, too little tissue support — the fold simply cannot hold.
Aggressive dissection during original surgery can damage the fold structure. Poorly placed incisions, excessive inferior pole dissection, and implant pockets created too large all contribute.
Tissue laxity — whether from natural predisposition, prior pregnancies, or weight changes — increases the likelihood of fold failure regardless of implant size.
Before planning correction, Dr. Tachmes evaluates the degree of fold descent, the quality and thickness of the remaining lower breast tissue, current implant size and position, and whether the implant size is appropriate for your frame.
Every bottoming out case is different. The repair technique must match the severity of the structural failure — not follow a one-size-fits-all protocol.
In cases where oversized implants are contributing to the problem, downsizing at the time of revision may be recommended to ensure lasting results.
Correcting bottoming out requires rebuilding the inframammary fold — not just replacing the implant. The repair technique depends on how much the fold has dropped and the quality of tissue available.
Dr. Tachmes performs inframammary fold reconstruction using a layered closure approach:
The over-dissected lower pocket is closed with permanent internal sutures, recreating the fold at the correct anatomical position and preventing further descent.
When native tissue is insufficient to hold the repair, Dr. Tachmes uses acellular dermal matrix (ADM) — a biological mesh that integrates into the tissue and acts as a durable internal scaffold for the fold.
The implant is repositioned into the repaired pocket. If the current implant size contributed to the bottoming out, Dr. Tachmes may recommend exchanging it for a more appropriately sized implant.
In cases where significant breast ptosis accompanies the bottoming out, a simultaneous lift (mastopexy) repositions the nipple-areola complex and removes excess skin for a natural result.
Recovery from fold reconstruction requires more activity restriction than a standard implant exchange because the repair needs time to fully integrate before being subjected to mechanical stress.
Dr. Tachmes provides detailed post-operative protocols for each patient. General recovery milestones include:
The repaired fold is most vulnerable in the first 8 weeks. Protecting the repair during this period is critical to preventing recurrence.
Surgery duration: 2–3 hours
Anesthesia: General anesthesia
Return to work: 1–2 weeks (desk work)
Compression bra: 6–8 weeks
Upper body exercise: Avoid 8 weeks
Full recovery: 10–12 weeks
Results stabilize: 3–6 months
Bottoming out correction is typically considered cosmetic and is not covered by health insurance. However, if the bottoming out is documented as causing physical symptoms — chronic pain, skin breakdown, nerve irritation — partial coverage may be possible.
During your consultation, Dr. Tachmes provides a complete fee breakdown including surgeon fees, anesthesia, facility, and implant costs. Financing options are available.
Every consultation starts with Dr. Tachmes personally reviewing your photos and history — not a coordinator or PA. Submit your case and receive a direct response about your correction options.
Submit Your Case for Dr. Tachmes' Review Call Now: 786-603-9074