What types of breast support can be used to prevent bottoming out when doing revision surgery?
Doctor Answers 3
SERI Scaffold or Strattice for bottomed out implant
Implants are less likely to bottom out if they are placed above the muscle.
Breast Revision for Implants that have Bottomed Out
Preventing bottoming out can be accomplished by understanding the patients’ tissues. For patients with weaker tissues or for patients who are at a higher risk for bottoming out, surgeons should be careful to select an implant that is not excessively large. An oversized implant would be more likely to stretch out the tissues. Additionally, a textured implant can help to reduce bottoming out, as these implants are more stable and less prone to shifting in the pocket than a smooth implant. As a result, these implants are safer for patients with weaker tissues. When bottoming out has already occurred, or in patients with an extremely high risk for bottoming out, reinforcement materials can be used. These materials are sutured into the edge of the pectoralis major muscle and down to the inframammary crease acting as an internal bra. There are many different material options out there. The ones I use most commonly are Strattice, which is an acellular dermal matrix. The other material I use commonly is Seri which is an ultra-purified silk mesh. Both of these materials are designed to be reabsorbed and replaced by the patient’s own tissue over a period of 1-2 years. Both these materials can provide extra strength, as it is important to support the soft tissue. The reason I sometimes use Seri over Strattice is because of the regenerative nature of the material. However, Strattice helps to significantly reduce the risk of capsular contracture and in patients who have had this issue in the past, it would be helpful to prevent it from recurring in the future. The materials are fairly expensive and require a high degree of expertise to use properly, so make sure once again that your surgeon has a significantly amount of experience with revision breast augmentation surgery.
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