Most commonly, implant ptosis, or “bottoming out”, happens when a patient’s tissues may not be strong enough to support the weight of the implant over time. It is more commonly seen in thin patients and with sub glandular placed implants, however, it can randomly occur with any augmentation patient. In rare cases, over dissection at the time of surgery can lead to implant ptosis, but this is generally not a common cause of bottoming out. Over dissection is readily recognized when, immediately postoperatively, the implant is noted to be positioned too low on the chest.

Correction of implant ptosis can be difficult and may require multiple surgeries. Capsulorrhaphy procedure to reconstruct the implant pocket is the gold standard for treating implant ptosis or malposition. If capsulorrhaphy by itself is ineffective, then the use of Galaform, Ovitex or Strattice (an acellular reconstructive tissue matrix to support the tissue and hold the breast pocket in the desired location) is required. Use of these products to support the breast are generally very effective but can be expensive. Occasionally, removal of the implant and capsule altogether is required. The patient can go back to surgery 4-6 months after healing and start over with a new augmentation procedure. These procedures can take anywhere from 1 to 7 hours depending upon the complexity of the condition.

It is a difficult problem to address surgically. Patients should remember that the larger implant is heavier and patients with thinner skin are more likely to bottom out leading to this challenging complication.