Best technique for bottoming out? (Photo)

Thank you for your pictures and questions. This is a really good question and probably one that will cause some debate. With plastic surgeons, the only right way to do anything is the way that they do it. Haha. I do not think that one technique is "superior" to the other, I think that it depends on the patient and her case. In your case, you have extremely thin implant coverage, bottoming out, rippling, etc. You have multiple issues that need a complex solution. I think that in your case, the problem is that you are lacking both support as well as implant coverage. In cases like that I think that acellular dermal matrix (eg Strattice) provides a better solution because it not only provides strength and support but also provides additional implant coverage and protection against capsular contracture, but it is a pricier option. It can create some additional rippling in cases though. You could also consider covering up the muscle with ADM and this would blunt the animation deformity as well. GalaFlex is a great product and does provide soft tissue support but dissolves over time so it does not provide any additional implant coverage (thickness to cover ripples, etc.) and also does note protect against cap con. I think your implant choice is also very important. In patients like you with rippling and thin coverage, I prefer to transition to a highly cohesive silicone gel implant that is slightly more firm but provides for much less settling and rippling of the implant.Make sure you are seeing a plastic surgeon who is board certified by the American Board of Plastic Surgery and has experience with revision breast surgery. This is the kind of case you do not want to put in the hands of someone who is giving you "the best price." You want the best solution. Hope this helps!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

Dear missaurab,
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