Bottoming out is usually seen in thin patients with very little breast tissue and skin coverage. It is more common with implants placed above the muscle, and is less common with implants placed in the total submusculofascial position (complete submuscular). The type of implant used does not have any relation to bottoming out. It can occur with smooth, textured, saline, or silicone gel implants.
"Bottoming out" means that the breast implants have descended too low on the chest, thus making the nipple too high on the breast mound. If bottoming out is apparent shortly after surgery, it is most likely due to over-dissection of the pocket. If it occurs later on, it is usually due to the weight of the implant.
In order to correct bottoming out, the scar tissue at the bottom of the pocket is rolled up to where the "new" (and higher) crease/fold will be. This can be done via any incision, but the crease incision is usually favored since it allows for better visualization of the pocket. Correction of bottoming out via the transax incision usually requires the use of an endoscope. If needed, other areas of the pocket are sutured and closed as well.