Which is superior: Galaflex or Strattice? Does Galaflex help prevent bottoming out and capsular contracture?

Bottoming out is often due to thinning and loss of implant support and coverage. In that situation, the capsule is not strong enough to support repair with capsulorrhaphy regardless of which sutures are used and how long you wear a bra. Adding support with ADM such as Strattice or mesh such as Galaflex creates an internal bra. The data is better for prevention of capsular contracture with ADM's but Galaflex should also work well for correction of bottoming out.

Unfortunately, you have not provided photographs or told us your bra size.  However, if you are having problems with your implants, an alternative to consider is explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.  Later, fat transfers can be performed if additional volume is desired.  Galaflex and Strattice provided only passive support.  The Bellesoma Method transfers the weight of the breast to the underlying pectoralis major muscle and provide active lift.  Best Wishes,Gary Horndeski, M.D.

 Thank you for your question and Generally I do agree with Dr. Widder  in that I think a really good capsulorrhaphy and even more importantly support for 6 to 8 weeks (I actually do it longer!) can solve the majority of bottoming out problems.  I too do a lot of revisions, and there are some women who simply need ADM… They just have way too thin of tissue and lack of support. I have also used Strattice in cases of persistent capsular contraction, which it seems to reduce.  I do not have any experience with Galaform and capsular contracture.  So for a first time bottoming out situation I almost always go to capsulorrhaphy as my first option…  

Dear Thoughtful,   Posting your pictures would have been helpful. I have been in practice for over 32 year and performed breasts augmentations and redo breasts augmentations on thousands of patients, including many bottoming out breasts. I have never used Strattice or Galaflex, because it is unnecessary. As a matter of fact, I operated on few patients who got Strattice by other surgeons and I had to remove ,at least, part of the material because of irregularities.    Bottoming out requires inferior capsulorrhaphy ( internal bra ) , which means excision of a sleeve of capsule at the sub mammary crease and suturing of the edges of the capsule with multiple permanent sutures , creating a higher level crease. After surgery you will have to wear a bra with a wire 24/7 for 6-8 weeks, to allow a strong scar to form at the crease. This technique worked for me very well without need for Strattice or Galaflex.   Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.                              Best of luck,                                              Dr Widder   

Dear Thoughtful2810,
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.
Regarding the Strattice and Gellaflex, every plastic surgeon has preferred type of product, which he uses. 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

This is a good question. The goal for bottoming out is to tighten the tissue and prevent it from stretching out again. Strattice when fully incorporated does not add additional strength, it does add thickness. Galaflex when incorporated has a 4 fold increase in strength over native tissues and thus is less likely to stretch further. Much depends upon the anatomy and implant size. I have over 100 galaflex cases now. No infections, 3 exposures that fully healed, and results that surpass my previous experience.There is a learning curve with this as with any other device. See someone with experience to optimize your results.

To date I have 241 Strattice cases and 150 Galaflex/Galaform patients in my database that I have operated on and have breast implants so I have a pretty good experience and understanding of these products. I have used Strattice for longer as it was available before Galaflex and also had a pretty large series of Seri before I switched to Galaflex. To the best of my knowledge there are no published studies out there comparing products so anyone answering is stating their opinion. There are studies showing reduction of capsular contracture with acellular dermal matrices (like Strattice) and I published my first 100 Strattice cases a number of years ago. I have not seen any studies with Galaflex or Galaform and capsular contracture.I have used Galaflex/Galaform a few times in patients after capsulectomy but at this time there are not enough patients for me to comment on reduction of capsular contracture rate. My experience with Strattice in that patients who have had capsular contracture and underwent capsulectomy and Strattice placement have a lower recurrence rate of capsular contracture then patients I have done capsulectomy on and not used Strattice.Currently, my preference is to use Strattice in patients in which I perform a capsulectomy for capsular contracture and to use Galaflex or Galaform in patients who need support but dont have capsular contracture. I tend to use Strattice in select cases without capsular contracture but need support and have very thin tissue as the Strattice gives more bulk then Galaflex or Galaform. I use a drain in all Strattice cases and I don't drain Galaflex/Galaform cases. I have had a few infections with Strattice and none with Galaflex or Galaform.In your case of bottoming out I would probably use Galaflex or Galaform and use it to support the repair. In terms of Galaflex sheet or Galaform shaped formed piece my preference depends on the issues

My own personal experience is with Strattice, both when it comes to surgery to prevent recurrent encapsulation as well as breast implant displacement problems.  I cannot comment on the efficacy of Galaflex. Best wishes for an outcome that you will be very pleased with.

Bottoming out can be largely prevented by minimal inframammary crease lowering at surgery and by using a specific well fit underwire bra 24/7 for 3 months and avoiding chest expecises and bouncy exercise for the 3 months while the capsule is forming. After the capsule matures, bottoming out is extremely rare - only 2 cases in my last 1,000+. So, prevention is very possible in most cases.