The two breasts commonly heal quite differently. One breast may swell more, feel more uncomfortable, or have a different initial shape. After complete healing, they will be more similar and natural. You must have patience, but if this causes concern, ask questions of the doctor or the nursing staff.
The final results are mostly present including "dropping of the implant" when implants are below the muscle within the first 3 months for most and certainly by a year. Breast implants initially after surgery when placed in a submuscular position often give superior fullness that corrects itself with time, the "fluff and drop" phenomena. In reality the pectoralis major muscle takes a while to adjust its size to accommodate the implant as well as occasional muscle spasm which keeps the implant projection higher than its final resting shape. As the muscle relaxes the projection of the implant often increases and the breast shape improves. Massage and use of a superior placed elastic strap can often make this process go faster.
ADM are good for capsular contracture and do help. The other factors are the breast implant size and native tissue thickness. It can be hard to treat
I'm so sorry you are dealing with a capsular contracture, they certainly can be frustrating. ADM absolutely can help reduce your risk of recurrence. It is important to see a board certified plastic surgeon who is comfortable with the treatment of capsular contracture. It is important to address all potential causes (biofilm/rupture), remove the entire capsule, and alter implant type/size and incision location if needed. The "dent" you describe can be addressed with fat grafting as well. Good luck!
I often do not go right to ADM for a CC because it is expensive to the patient. But, yes, it can help reinforce the repair for a bottoming out. I use ADM all the time for breast reconstructions.
In my experience Strattice has been very effective at preventing recurrence of capsular contracture. When treating CC, typically the scar capsule is removed (capsulectomy) and a new implant placed. The capsulectomy removes some of the support and coverage for the implant so the Strattice also addresses that issue by replacing the tissue. Although expensive, it is much cheaper than another surgery.
I am sorry to hear about the complications you have experienced. Capsular contraction can be a very frustrating complication for both patients and surgeons. In my practice, I have found the most success treating these difficult problems utilizing techniques such as sub muscular pocket conversion (if relevant), capsulectomy, use of fresh implants, and the use of acellular dermal matrix. Yes, this material may also be helpful in certain cases of breast implant displacement, including bottoming out situations.
In regards to the success of the revisionary breast surgery, careful selection of your plastic surgeon will be the most important decision you make. I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.
Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery.
***Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.
I hope this, and the attached link/video, helps.
In my experience, the use of an acellular dermal matrix like Strattice, has been very useful for patients who both have bottomed out breasts and recurrent Capsular Contracture. Strattice is a purified form of pigskin that becomes integrated with your body's own cells over a month or two. Thus far in my practice, I have not seen capsules return when a fair amount of the capsule is replaced by Strattice. The downside is the Strattice costs which range between $4000 and $8000. Try to find a board-certified plastic surgeon with demonstrated knowledge and expertise in revision of breast surgery using ADMs. best of luck.
The reason is hat ADM is $4,000 to $12,000 and does not guarantee that the problem will be fixed. It is also human cadaver skin that has been removed of its cells, it is not, however, sterile. So there is limited data.