Several factors can contribute to the need for support with SERI Scaffold, GalaFLEX mesh, or ADM's such as Strattice and Alloderm in revision breast surgery. If the skin is thin and stretched out, there will be less support for implants, especially large ones. Multiple surgeries often cause tissue weakening as well, more so when scar tissue has to be removed. Ultimately it is a judgment call by the surgeon but these materials definitely fulfill a need.
There's no absolute answer to your question. Not withstanding, if your tissues are thin, you are more likely to drop with a larger implant. Although these devices such as ADM's and Seri are relatively expensive, they do add additional support. The cost, however, can turn out to be less than a future third revision.
Ary Krau MD FACS
Thank you for the good question. In my practice, I make recommendations regarding the use of additional “support devices” such as acellular dermal matrix based on the patient's past surgical history, physical examination, and goals. For example, if a patient has had failed revisionary breast surgery (for example, for breast implant malposition) she may benefit from the use of additional support of material. Likewise, if the patient has a history of previous breast implant exposure, the use of additional tissue between the breast implants and the overlying skin may be helpful. Or, if the patient's tissues appear to be thin with minimal supportive strength, it may be in her best interests to have additional support of material utilized. Furthermore, if the patient examination reveals significant breast implant rippling/palpability or if she wishes to maintain significant superior breast pole volume then additional supportive material may be useful. You may also find the attached link, dedicated to revisionary breast surgery concerns, helpful to you as you learn more. Best wishes.