What are the pros and cons of using mesh to fix and further prevent bottoming out? (Photo)

Repositioning a malpositioned implant can be a challenging process, especially in a case as significant as yours. There are many variables that can lead to this problem -- implant size, soft tissue strength, implant texture, and surgical technique all contribute to final position.  You appear to have a reasonably large implant and to have undergone some sort of lift at the time of your original surgery, so I will presume that your tissues are fairly soft and their strength compromised.  In cases like this, the placement of some type of supporting material can help reduce the risk of recurrent malposition.  Products like Strattice, Flex HD, etc are collagen meshes made from various animals.  Other materials can be used, as well.  SERI is made from silk, for example.  In all cases, the benefits are better support for the implant long-term and perhaps better soft-tissue coverage to hide rippling and palpability.  The downsides are not insignificant, however.  These products are expensive and challenging to use correctly.  They add to surgical complexity and operative time, and can introduce other deformities if not expertly placed.  I would also state with relative assurance that your skin envelopes are very different, and that some sort of mastopexy will be necessary at the time of implant repositioning.Of note, it appears in your photo that your right breast is significantly larger as well as being lower.  If this is actually the case, you may have fluid around your implant which can further complicate matters.Make sure that your surgeon has extensive experience with complex revisions, as yours is not an easy case, but with proper care you should be able to achieve a significant improvement in breast shape and symmetry.

The so called periareolar (yes, it happens around the areola) mastopexy (it can't be named as pexy or lift) popularized by Benelli and Goes few decades
ago is the most frustrating novelty and progress in cosmetic surgery
(followed closely by endoscopy).Essentially these are the flawed features of the periareolar mastopexy in the best hands and correctly executed:-flattened breast, "fried egg"-shaped-"sun beams" around the areola due to the folds made to encircle a large circular edge downsized to a tiny periarolar edge of the wound-overtension of the scar, leading to hypertrophic scarring of awful cosmetic quality, if not keloyd-this overtension enlarges the areolas looking like cookies, furthermore elongated vertically most of times-cutting away sking all around the areola leaves the areola in the same place, this means no uplift of NAC at all-no glandular work, no reshaping, no support, no lift is achievedYou
are not the first and will not be (unfortunately) the last to become
victim of the seducing "scar-less" uplift. It is not a matter of finding
the "best surgeon" to perform it, it is question of finding a surgeon
who does not practive this technique.The solution is not a mesh or any other "creative" or miraculous solution, you just need a BREAST LIFT, a normal one, a real one, well executed and indicated, with inverted T scars (Wise pattern), and better implants: wider, anatomical shaped, macrotextured to provide adhesion to ribcage, cohesive gel filled, of the latest generation. In other words: a full revision.Seek other opinions, specially from surgeons expert in revision cases, complex situations and breast lift. Do travel where is required.