Best technique for bottoming out? (Photo)

The technique I recommend for bottoming out 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.    Best Wishes,Gary Horndeski, M.D.

Good morning!I prefer Strattice, because of its anti-CC properties and ability to reduce rippling, and I correct bottoming out with the Original Internal Bra, my strong permanent internal suturing technique, which was designed for bottoming out correction. It is the most common procedure I perform, 5-6 times a week, for patients from around the world!

Galaflex mesh and Strattice are both good options for an internal bra to add implant support, though Strattice will add more immediate coverage. The animation deformity is another matter, and will not be definitively corrected by the same method. Consider converting to the split muscle plane (you have dual plane now). This will preserve muscle coverage over the upper pole but re-attach the part of the muscle  that was cut. Many examples of this type of repair on my website.

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

Both techniques usually give good results, and surgeons usually have their preference depending upon their experience. If your implants are large and heavy, I would recommend going down in size. Bottoming out and thinning of breast tissue occurs more with heavy large implants.

Thank you for your question. There are many ways to correct bottoming out. Some include capsulorrhaphy, placement of dermal matrix, and external Ryan flap. Based on the amount of rippling you have, placement of the dermal matrix may hide the rippling better. Fat grafting may also be an option to hide the rippling. I recommend consulting with a board-certified plastic surgeon in your area who is also a member of the American Society of aesthetic plastic surgeon for a consult. Best of luck with your procedure.

Using biological materials as a mesh to help prevent recurrence of bottoming out post op unfortunately is extremely expensive often running several thousand dollars. It is not a rare problem. I find using mesh almost never necessary if the crease is repaired properly using your existing tissue. If it has been repaired twice before and still fails then mesh could be the solution. Animation deformity to some extent happens in all submuscular augmentations. Exaggerated or just one side treatment is very unpredictable and often unsuccessful. Your ripling could be much improved with a Mentor HPX implant. Fat grafting can also be done to thicken the tissue over problematic rippling areas. 

Great question on galflex vs strattice. I use both regularly. In fact last week I did one of each on same day. I like strattice post capsulectomy if there is capsular contracture as there is a biologic mechanism to the ADM helping to prevent recurrence. If tissues are very thin and I need to thicken them a bit I also like strattice. For just support galaflex/galaform works really well and are much less expensive then strattice. The popcorn technique helps with either product in shrinking the tissues. In your case an in person consultation with examination of how thin the tissues are would help.