Feeling a breast implant at the bottom is a common sensation, ranging from subtle awareness to a pronounced feeling. This article explores why this occurs, from normal healing to potential issues, and when to seek medical advice.
Understanding the Sensation
Feeling a breast implant at the bottom can manifest as a firm, distinct edge along the lower curve of the breast. Visually, this might appear as the implant sitting lower than anticipated or creating an unnatural bulge in the inframammary fold, the crease beneath the breast. While implants initially sit high after surgery and gradually settle, persistent or worsening sensation, or accompanying changes, may indicate an issue.
Common Explanations
Several factors can contribute to the sensation of feeling a breast implant at the bottom, ranging from expected post-surgical changes to more specific conditions.
Implant Settling
A natural part of breast augmentation recovery is implant settling, also known as “drop and fluff.” In the initial weeks after surgery, implants often appear high and somewhat firm because the pectoral muscles and surrounding tissues are tight. As these tissues gradually relax and adapt to the implant’s presence, the implant gently descends into its intended position within the created pocket, usually over 6 weeks to 6 months. This process allows the lower part of the breast to fill out, creating a more natural contour.
Rippling or Folding
Breast implants, particularly saline-filled implants or those with thinner shells, can sometimes develop ripples or folds in their outer surface. These folds can become palpable or even visible through the skin, especially in individuals with minimal natural breast tissue to provide adequate coverage. The sensation might be described as feeling distinct ridges or wrinkles, often more noticeable at the edges or lower pole of the implant. Weight loss after surgery can also thin the tissue covering the implant, making rippling more apparent.
Bottoming Out
“Bottoming out” occurs when a breast implant descends too far down the chest wall, extending below the inframammary fold. This can result in an overly elongated lower breast pole and may cause the nipple to appear higher than its natural position. Factors contributing to bottoming out include an implant size that is too large for the patient’s tissues, weak breast tissue lacking elasticity, or an inadequately supported surgical pocket. It can also be influenced by the surgical technique, such as if the inframammary fold is not properly reinforced.
Capsular Contracture
The body naturally forms a fibrous capsule of scar tissue around any breast implant. Sometimes, this capsule thickens and tightens around the implant, a condition called capsular contracture. This tightening can make the implant feel firm or hard and alter its position, making its lower edge more noticeable. Even mild contracture can contribute to the sensation of the implant being felt at the bottom.
Implant Malposition (Downward Migration)
Implant malposition refers to the implant shifting from its intended position within the breast pocket. Downward migration specifically describes the implant moving too low on the chest wall. This can happen if the surgical pocket created for the implant is too large or if the natural tissues supporting the implant weaken over time. The sensation of the implant resting at the bottom of the breast or even below the natural breast crease is a common symptom of this type of malposition.
When to Consult a Professional
While some sensations after breast augmentation are normal parts of the healing process, certain signs and symptoms warrant prompt medical evaluation. Contact a plastic surgeon or healthcare provider if you experience:
New or increasing pain, especially localized to the lower breast or implant area, that does not respond to medication.
Significant changes in breast shape or symmetry, such as one breast appearing noticeably different or the implant visibly shifting.
Signs of infection, including increasing redness, warmth, swelling, or a fever over 100.5 degrees Fahrenheit.
Foul odors or unusual discharge from the incisions.
Any sudden onset of symptoms, or a feeling that something is not right.
Any concerning symptoms should prompt a discussion with a healthcare professional for proper diagnosis and timely management.
Potential Solutions and Management
Addressing the sensation of a breast implant at the bottom requires a tailored approach, as the solution depends on the specific underlying cause.
Non-Surgical Approaches
For natural implant settling, observation is often sufficient, as implants typically achieve their final position over several months. Specialized massage techniques or supportive garments might also encourage proper positioning. Non-surgical interventions have limited effectiveness for more significant issues like malposition or contracture. However, for mild rippling, improving tissue hydration or modest weight gain could potentially make the implant less palpable.
Surgical Interventions
When non-surgical methods are insufficient, surgical revision is often considered. If capsular contracture is the cause, a capsulectomy may be performed to remove or release the hardened scar tissue, aiming to alleviate firmness and restore a natural breast contour. For bottoming out or downward malposition, surgical options include implant repositioning or pocket revision, where the surgical space is reshaped and tightened. This might involve internal sutures to reinforce the inframammary fold, sometimes called an “internal bra.”
An implant exchange, replacing current implants, might be recommended if the implant type, size, or material contributes to the problem. In cases of significant skin laxity or breast droopiness, a mastopexy (breast lift) may be performed. This procedure repositions the nipple and breast tissue higher, creating a more aesthetically pleasing shape and enhanced support. The choice of solution is highly individualized and determined after a thorough evaluation by a plastic surgeon.