450cc, 5'4, 120lbs & bottomed out implant will mesh/cadaver skin fix this issue? (Photo)

Question

I have Breast Augmentation June 2022! I knew something was wrong in the 1st few months, one bottomed out. Doctor said he would do a revision with either mesh or Cadaver skin, I'll have to pay for operating room only. Will this work to fix issue? I was also wondering would it be a bad idea to change implant to 550cc while he's in there? I have 450cc now, I'm 5'4 and 120 lbs.

Richard Baxter, MD · Answer

I think an internal bra is a good idea to restore support to the implants. I would use Galaflex mesh over acellular dermal matrix in your case. Going larger will add more weight and will make it more difficult to hold the implants up over the long term.

Sean T. Lille, MD · Answer

I am a fan of Strattice- a reconstructive mesh and use it frequently in my practice. It could be helpful in this case. However, increasing the size of implants will only increase your risk of more problems. I would not do that.  
*This is an opinion and in no way meant to supersede your surgeon's advice.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion of my practice is dedicated to revision breast surgery.  Your implants have definitely bottomed out, however you do not need mesh.  I wrote the very first paper on the internal bra-capsulorrhaphy over 20 years ago.  You should be able to have an excellent result.  Best wishes to you.

Shlomo Widder, MD · Answer

Dear Vivid,
   Thanks for posting your picture and sorry for your sub optimal outcome. From observing your picture the following is noticed:
1. Bilateral bottoming out, more so on the right side. The solution for that condition is inferior capsulorrhaphy (internal bra) , which will raise the sub mammary crease to more natural and attractive position. It will also give you a fuller upper pole. You will have to wear a bra 24/7 for 6 weeks in order to protect the repair. It is unnecessary to use mesh or cadaver skin !
2. Wide cleavage. This will require medial capsulotomy (scar release) to allow the implants to move more towards the mid line and give you a nice cleavage. You will have to perform medial implants displacement massage daily for 6-12 months in order to maintain a nice cleavage.
3. Right side bigger. Size adjustment can be done.
4. Most likely you will need upper capsulotomy in order to allow the implants to move upward with the capsulorrhaphy maneuver and definitely you will need it  if you want larger implants, which require larger pocket to accommodate bigger implants.
     Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after picture of redo breasts augmentation in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky and natural look.
                  Best of luck,
                               Dr Widder
                       widderplasticsurgery.com

Daniel Barrett, MD · Answer

Dear Vivid798532,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Shana Kalaria, MD · Answer

I would recommend surgical revision with internal capsulorrhaphy +/- mesh and implant exchange. Using mesh will likely be successful to fix your issue, but only if you keep the same size or go smaller. With a larger implant it will put too much pressure on the repair and will likely bottom out again in the future. Also, your frame is small and 550cc will look too large in my opinion as your implants are already wider than your chest wall. Please see a board-certified plastic surgeon for your revision. Good luck!

Connie Hiers, MD, FACS · Answer

You are bottoming out because your implants are too large and heavy for your tissue to support. If you go larger, you will just sag sooner and more. You need to go down in size and support your tissue with an internal bra of mesh.

Camille Cash, MD · Answer

Bottoming out can occur for several reasons.  Adding the mesh should help to better support the implant to keep this from happening again.  Exchanging for larger implants will put more weight on the tissues and may be counterproductive.  I encourage you to speak with your surgeon about the risks and benefits.

450cc, 5'4, 120lbs & bottomed out implant will mesh/cadaver skin fix this issue? (Photo)

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