What types of breast support can be used to prevent bottoming out when doing revision surgery?

I need a breast revision, I want to know what are the options available to prevent bottom out breast ? What is matrix, what other materials are used and what's the difference ?

Doctor Answers 3

SERI Scaffold or Strattice for bottomed out implant

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Acellular Dermal Matrix or ADM is made from skin with the cells removed, so it functions as a template for your body to generate a new layer of tissue. Strattice is made from pigskin and works very well. A newer material called SERI scaffold is derived from purified silk. This also transforms into a layer of tissue over time, and is less expensive than Strattice. The concept is like an internal bra.

Implants are less likely to bottom out if they are placed above the muscle.

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Bottoming out is an infrequent complication of breast augmentation. It is seen less frequently when the implants are placed above the muscle as this eliminates the vector of force generated upon the prosthesis when the implant is pushed upon by the engaged pectoralis muscle.

Breast Revision for Implants that have Bottomed Out

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With breast revision surgery there are many potential ways reconstruct the breast and create a nice overall appearance. This type of surgery can be very complicated and should be performed only by a very experienced Board Certified Plastic Surgeon. One issue that patient’s encounter after breast augmentation is bottoming out, which generally implies a stretching of the skin between the nipple and the inframammary crease or breast fold causing the breasts to take on a somewhat droopy appearance. Depending on various situations, there are multiple options to deal with this problem. Prevention of bottoming out is a separate issue, but also requires forethought on the part of the surgeon.

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.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.