Is mesh more reliable for breast revision surgery than sutures? Bottoming out

Question

I am bottoming out due to my breast aug from July. I do not think my dr is very experienced in revision surgeries and has not been able to help me much with my questions. I want to have a revision surgery as I am very unhappy with the results :( I understand sutures tend to have to be redone, and I would really want to avoid that. I was wondering if getting mesh instead would be more reliable and less likely need to be redone? Thanks

Edwin C. Pound, III, MD · Answer

I have been in practice for 25 years and seen all kinds of problems related to breast implants and their pockets.  I can usually repair these with sutures alone.  Acellular dermal matrix (Seri, Surgimend, FlexHD, Alloderm, etc.) may reinforce these repairs but that stuff is VERY expensive.  The risk of recurrence is a risk no matter what you do.  Fortunately, I have only had maybe one or two patients over the years that I had to take back to the operating room for a second repair.

Richard Baxter, MD · Answer

When implants bottom out, it is often because of loss of support due to thinning, stretching, and weakening of the tissues around the implant. Putting sutures into thin weakened tissue will not always be successful, because the repair still depends more on the tissues than the sutures. If that is the case then reinforcement of the repair with a material such as SERI or GalaFLEX mesh will provide more secure long term support. Another common solution is Strattice. A lot of this depends on the size of the implants.

Tom J. Pousti, MD · Answer

I am sorry to hear about the complication you have experienced. I agree with you that plastic surgeon experience does matter when it comes to the success rate of revisionary breast surgery.   Most patients who undergo this type of revisionary breast surgery  benefit from capsulorraphy (internal suture repair). This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation.  In my practice, I use a 2 layered suture repair,  supporting the involved area.   I do not find the use of acellular dermal matrix or mesh necessary for the majority of patients who present with breast implant displacement problems.  Factors such as recurrence of breast implant displacement/malposition and the presence of poor quality skin/tissue support come into play when making a decision to  recommend/utilize additional support materials.
Generally speaking, the use of acellular dermal matrix  or bio synthetic mesh for patients in your situation may be helpful occasionally. This material may be helpful as a supportive matrix and help with the breast implant displacement/malposition you are experiencing. Again, I usually recommend their use depending on the patient's anatomy ( for example quality/elasticity of the involved skin) and past surgical history.
You may find the attached link, dedicated to revisionary breast surgery (demonstrating many cases of corrective surgery for patients with "bottoming out" of breast implants) helpful to you as you learn more.  You will find a separate page, on the same website, dedicated to bottoming out situations specifically.
Best wishes.

Mark T. Boschert, MD · Answer

If you are experiencing bottoming out this soon after surgery then I would suspect that you will need some sort of internal support such as a biological a cellular dermal matrix product or a mesh such as Seri. Each of these has different properties and are used for specific indications. I would discuss this with the board-certified plastic surgeon in your area who may be familiar with breast reconstruction and revisionary breast augmentation procedures. Don't worry, you can have a long-lasting improved result.Good luck!

Steven M. Camp, MD · Answer

Thanks for your question about breast implant surgery.It is difficult to give much guidance without photos, but if you are bottoming out you will most likely be happiest with correction to the area.  The manner of repair depends on what your surgeon may discover on your exam and during surgery.  In many cases of bottoming out after breast augmentation surgery it is possible to reconstruct and firm up the inframammary fold with suture techniques and I perform this on all of my primary breast augmentations to minimize the chances for breast implants bottoming out.  In cases of significant soft tissue looseness it may be necessary to use a biomaterial or mesh.  I have used Galaflex, SERI, and Alloderm and Stratus to correct these issues.  Each of these materials or (meshes) has different properties which can be used for different reasons.  Make sure to discuss your concern with your surgeon.Best Wishes

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