Bottoming out is a form of implant malposition. Essentially one side the implant stretches the skin of the lower part of the breast causing the nipple to appear higher and no longer be centered on the breast mound. This can result in marked asymmetry of the breast. The cause is multifactorial, contributing factors include the weight of the implant, weight loss of the patient, and technical issues caused by the initial surgery. The most common procedure leading to bottoming out is an augmentation with a breast lift. This is a difficult procedure because of combining two opposing procedures, implant malposition is not unusual leading revisional surgery.
This 31 year old woman presented with bottoming out of left implant. You can see the left nipple is higher than the right one. This is caused by the implant stretching the lower portion of the breast causing the nipple to go up. There was also a partial deflation of the right implant. Revision was performed where silicone implants were placed and capsulorrhapy done on the left pocket to fix the bottoming out.