Breast implant replacement, with or without mesh?

Bottoming out can happen for a variety of different reasons. This causes the implant to drop below your natural fold and causes the appearance of two folds (one were the bottom of your implant now sits and one that it the crease where your old fold was.
Newer strategies to reconstruct the strength of this fold include using an internal bra (most commonly either galaFLEX mesh, alloderm matrix). The galaFLEX mesh is a synthetic absorbable product made out material similar to dissolving stitches. The goal is for it to act as a scaffold over time while your body fills and replaces the scaffold with it's own strength layer. Alloderm is an alternative, aceullar human cadaver-based scaffold.
Silicone implants are lighter compared to the same-sized saline implant, so would theoretically have less risk of bottoming out compared to their saline counterparts.

Dear MTJohnson0207,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

If you have sagged, I do not recommend going with large heavy implants like 500 cc's because you can sag again, even with mesh. there are different kinds of mesh, some temporary to give support while healing, and some permanent. Permanent mesh is more foreign material in your breast.