and is helpful when you need your implant securely positioned or your tissue augmented to help diminish rippling and palpability. I try everything I can to avoid using those products as it still is a foreign material that increases risks but they do become necessary in certain situations.
Whether we use SERI, Strattice, Alloderm, or GALAflex mesh, you are correct that fixation is important. However, keep in mind that because these materials reinforce the weakened tissues, the tissues become stronger. I believe the most important aspect of the fixation is to the chest wall, which in patients with implants is the part of the scar capsule behind the implant. I make a "cuff" of the material which attaches there and then drapes around to the front of the implant, forming a bra cup. Fixation is also done by suturing to the muscle fascia, so we don't rely on the thinner weakened tissues to support the material but rather the other way around.