Bottomed Out with Mesh - Will adding more mesh prevent me from bottoming out again? Should I ask for smaller implants?

Question

Hello. I am 10 months post op - 295cc implant with internal bra/galaflex mesh. They’ve always felt very heavy despite. I am now planning for a revision with more mesh. I asked if I needed a smaller implant and was told I did not. Will adding more mesh prevent me from bottoming out again? I was under the impression the internal bra was supposed to prevent that in the first place. I don’t want to have corrective surgeries every year. Should I ask for a smaller implant?

Michael A. Fallucco, MD, FACS · Answer

Thank you for sharing your concerns—it’s completely understandable to want clarity and a long-term solution. At 10 months post-op, it's not uncommon to still be evaluating how your implants are settling, especially with the added support of Galaflex mesh. The internal bra is indeed designed to provide structural support and help prevent issues like bottoming out, but in some cases—particularly if there are factors like weaker tissue, implant weight, or surgical technique—it may not fully prevent recurrence. Adding more mesh can enhance support, especially if your tissue has stretched further, but it’s not a guaranteed permanent fix if the underlying factors aren’t addressed. If your implants feel heavy and you’re already concerned about longevity, it’s reasonable to revisit the idea of downsizing slightly, even if your surgeon doesn’t believe it’s strictly necessary. A slightly smaller implant may reduce gravitational pull on the lower pole and improve your comfort, which could help preserve your results longer and reduce the likelihood of needing repeated revisions. A thoughtful, individualized approach that balances aesthetic goals with tissue stability is key—don’t hesitate to seek a second opinion if you’re unsure.

Ira H. Rex lll, MD · Answer

Mesh is certainly not a cure all for bottoming out.  Did you have a breast lift?  Bottoming out is not that common with just augmentation and using mesh at the first operation is not often indicated.  Often switching to smaller implants does make a number of different problems a bit more easier to take care of surgically.

Camille Cash, MD · Answer

Bioabsorbable mesh is helpful in giving support to the tissues to help prevent complications such as bottoming out, but there are no guarantees.  Smaller implants weigh less and may also help since less force will be placed on the breast tissue.  I encourage you to visit with a few board certified plastic surgeons near you if you are unsure about your recommendation.

Mats Hagstrom, MD (license on probation) · Answer

When implants bottom out, it’s due to the surgeon not having maintained the integrity of the IMF or infront mammary fold.
The outcome is due to surgical error and if the revision didn’t hold up, it’s because your surgeon couldn’t do it.
Some situations are more difficult than others.
How much experience does your surgeon have correcting this deformity?
Ask providers to open up their portfolio and show you their entire collection of before and after pictures for whatever operation they are recommending.
Ask them what their tracker record has been in the past and how often they do this procedure.Correcting bottomed out implants can be difficult, but can be done without recurrence if done correctly.
Consider getting a few in person second opinion consultations with other plastic surgeons in your community .
If you don’t know who to consult with, then consider looking up who does most of the breast cancer reconstruction in your community.
Plastic surgeons who do a lot of breast reconstructive surgery usually have experience taking care of complex situations.Best,
Mats Hagstrom MD

Bottomed Out with Mesh - Will adding more mesh prevent me from bottoming out again? Should I ask for smaller implants?

Answers (4)

Answer: What you should ask for

Answer: What you should ask for

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Bottomed Out with Mesh - Will adding more mesh prevent me from bottoming out again? Should I ask for smaller implants?

Answers (4)

Answer: What you should ask for

Answer: What you should ask for

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Recommended reading

Everything you need to know about Breast Augmentation

Our mission is to create a world where every investment in modern beauty is Worth It.