Does a breast implant that has fallen below IMF fold need revision using strattice in order to prevent dropping again?

Question

One implant has dropped too far where my nipple is sitting high on top of breast mound and the implant sits below the IMF fold. Is strattice usually necessary in a revision for this problem to prevent the implant from dropping again? My revision will also use a smaller implant than original as well as a lower profile. Original was 345cc inspira high profile with a projection of 4.9cm. I will be revising with a 300cc mentor implant at a moderate profile. Thank you.

Tom J. Pousti, MD · Answer

I am sorry to hear about the problem you are having after breast augmentation surgery. 
 Generally, signs of breast implant bottoming out include: 
1. Breast implant "sits" too low on the chest wall.
2.  Excessive palpability or visibility of the breast implant along the lower breast pole.
3.  Nipple/areola complex seems to be sitting relatively high, because the breast implants have settled too low. 
4. Discomfort along the lower breast pole (secondary to pressure from the underlying implant).
5. Relative paucity of upper pole breast implant volume compared to lower pole volume.
6. Increased visibility of a infra mammary fold scar (higher on the breast mound).
 Patients who experience bottoming out of breast implants typically benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). Sometimes, depending mainly on the patient's history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh. This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes and visibility of the inframmammary fold scars (if present) should improve with this operation.
There are several important "factors" involved in this type of revisionary breast surgery. Most important (in my opinion): plastic surgeon experience level.     In other words, experience level and technical expertise play the biggest role when it comes to successful  outcomes with this type of revisionary breast surgery.   Careful attention to postoperative activity limitations as well as use of appropriate postoperative support of dressing/garments are also important.
 I hope this helps.

Richard Baxter, MD · Answer

The answer depends on why the bottoming out occurred. It is typically because the tissues thinned leaving inadequate support, and this happens more often with large implants. However yours are not especially large and since it only happened on one side, you might be able to get by with capsule repair (capsulorrhaphy) alone. Galaflex mesh is a less expensive option than Strattice, though Strattice has a longer record of clinical use for this application.

William Bruno, MD · Answer

It's possible to correct bottoming out with a repair of the capsule alone or in combination with mesh support such as Strattice (permanent) or Galaflex (resorbable). Exam of your tissues and photos would be important to give you more recommendations. Consult with a few surgeons in person for a detailed exam.Best wishes,Dr.Bruno

Amy T. Bandy, DO, FACS · Answer

Thank you for your excellent question!  Strattice is definitely not your only option.  It sounds like you have a very realistic plan to address this issue.  Hopefully you can get away with a capsulorrhaphy to close off the pocket.  I recommend that you consult with a board certified plastic surgeon in your area to discuss your options.  I wish you the best of luck!

Daniel Barrett, MD · Answer

Dear huckfc,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Does a breast implant that has fallen below IMF fold need revision using strattice in order to prevent dropping again?

Answers (7)

Answer: Bottoming Out

Answer: Bottoming Out

Answer: Bottoming out

Answer: Bottoming out

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Everything you need to know about Breast Implant Revision

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Does a breast implant that has fallen below IMF fold need revision using strattice in order to prevent dropping again?

Answers (7)

Answer: Bottoming Out

Answer: Bottoming Out

Answer: Bottoming out

Answer: Bottoming out

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Recommended reading

Everything you need to know about Breast Implant Revision

Our mission is to create a world where every investment in modern beauty is Worth It.