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

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.

Your question is very valid.  Corrective breast surgery can be very trick and unpredictable.  I would agree that it appears as though you have bottoming out or "inferior implant malposition" of your right breast.  I would agree that using mesh as a "hammock" near your fold would give additional support to your implant and may lessen the risk of this recurring.  Several mesh materials are available.  I prefer to use Seri graft in these cases. Overtime this mesh will dissolve and structural support of your own collagen will remain to aid in providing support.  Without mesh your natural capsule will probably restretch over time.   A smaller implant may also be needed to lessen the weight on your lower breast skin.  I hope this was helpful.  Best of luck. 

Bottoming out occurs as a result of inadequate support of the implants by the body's tissue envelope. This is especially likely with larger implants as yours appear to be. The idea of using mesh such as GalaFLEX to create an internal bra is to reinforce the tissues and add internal support. Exercise will not strengthen the tissues that support the implants. 

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.

Dear kmcbride1977:Thank you for posting your photo.   If you are experiencing bottoming out and recurrence of sagging from your initial augmentation and lift procedure, my internal bra technique could be a very good option for you.  When a patient's own tissue is not strong enough to "hold up" your implant or the infra-mammary fold crease has been weakened from weight loss or prior surgery, the use of something else besides your own tissue as an internal bra can definitively address these challenges.   This "something else" can be a dermal matrix product (a sheet of collagen from pig skin (called Strattice) or a human cadaveric source (called AlloDerm)), a silk mesh product (called SERI), and a sheet of a dissolvable mono-filament suture material (called GalaFlex).   These materials serve as the internal bra to hold up your implant and breast tissue.   Often with these internal bra technique, a revisional mastopexy of some form is require to redrape the skin to yield a better breast shape.   I do a lot of complex revision breast surgery on a weekly basis to correct bottoming out and/or implant malposition or synmastia, and I can report zero recurrences with my internal bra technique.     In my hands, it is a very reliable option.  However, it is much more complex surgery (hence the costs are much higher) and the swelling from the procedure can last several weeks which is normal.   Please visit with a board certified plastic surgeon well versed with the internal bra technique to learn more about your options.  Best wishes,Dr. BasuHouston, TX

I think there is a paucity of information because this is a relatively new approach.  The pro's of using mesh reinforcement are the strength of the material.  The con is perhaps that it can make future mammograms a little more difficult to interpret.  This has not been clearly established.  You may also wish to discuss a neopocket approach with your surgeon, and the use of a smaller implant.

Easy. The pros are that the implant has a much better chance of staying in position, and cons are that it could contribute to an infection depending on what type of mesh used. But, you definitely need mesh to hold that implant in place. I'd probably use Strattice or Seri to really help hold it steady since you work out so much. Alloderm will continue to sage somewhat over time because of its inherent natire

I am sorry to hear about the complication you have experienced.
I think your concerns are appropriate; your breast implant does seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”).
I think you will benefit from revisionary breast surgery which will likely involve 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.
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. 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 more information about specific pro's and con's on the Mesh manufacturer website.
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.
Best wishes.

There are several options available to support the lower portion of your implant.  Galaflex is a type of mesh that slowly dissolves but leaves you with collagen for support.  Another  option would be one of the several acellular dermal products.  These are typically made from cadaver skin.  The cost is the major downside of all of these options.  Good luck