Internal bra for bottomed out implant - is it necessary? (Photo)

Dear Aleedo,

Thank you for your question—and I truly appreciate how thoughtful you’ve been in researching your revision options.

The explanation your surgeon provided is clinically sound, especially since you're working with a smaller implant size and they believe your existing scar tissue (capsule) can provide sufficient support. That said, in my 20+ years of experience, I strongly believe that “an ounce of prevention is worth a pound of cure”—particularly when you're already dealing with capsular contracture and implant malposition.

When it comes to preventing bottoming out from recurring, I prefer a more proactive approach—especially for patients undergoing revision surgery. While GalaFLEX mesh is an excellent tool in the right setting, I’ve had tremendous success using Strattice, a biologic mesh derived from porcine dermis. It’s designed to reinforce the lower pole, integrate naturally with your tissue, and minimize implant movement over time. This added internal support can make all the difference in reducing the risk of yet another revision down the road.

Even with smaller implants, the quality of your tissue, history of contracture, and symmetry goals matter. Using Strattice provides a biological scaffold that helps restore strength and structure, especially in areas where natural support has already failed.

Before making your decision, I recommend asking your surgeon:

How they’ll ensure long-term implant stability
What they’ll do if the scar capsule weakens again
And whether Strattice or similar biologic materials could improve your outcome
Warmly,
Earl Stephenson, Jr, MD, DDS, MBA
ESJ Aesthetics – “Where Confidence Takes Shape!”

Thank you for your question. I have been in practice over 30 years, and complex breast revision surgery is a large portion of my practice. You have a more complicated problem then just fixing the bottoming out on the right. I agree with your surgeon that you do not necessarily need some sort of mesh. I do not think mesh would hurt, but not 100% necessary. I definitely would have to revise both pockets and also do something to make your areolas more symmetric as well. I would recommend doing a internal bra/capsulorrhaphy on the bottomed out breast and assess the tissues. If the tissues are weak, then I would use a mesh. I would also perform some sort of pocket modification on the other side as well. You should be able to have an excellent result, but definitely need a pro to do your work. Best wishes to you.

Based only one post a photo best in person or virtual consultation, but I agree using some type of internal bra mesh in addition to capsulectomy and exchange of implants to new implants. Expect fee to be $15-$25,000. Best of virtual consult with.