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

Bottoming out will occasionally occur after aggressive treatment of capsules. This is probably more common after total capsulectomies. In retrospect, using an ADM such as Galaflex may have been helpful at the time of the capsule treatment. To now correct this condition, most surgeons would perform a capsulorraphy. An ADM is not always necessary as there will be some recurrent capsule present that could be used for the repair. I personally make this an intraoperative decision, i.e. I decide whether to use an ADM depending on the findings in surgery.

I would recommend a complex breast revision including removing the diseased capsules, placing new implants and Galaflex. Capsular contracture requires that the diseased capsules are removed. If you do not remove the capsules, there is a 50% chance of recurrence of the capsular contracture.

Hi Alledo. Thanks for your question. I'm so sorry to hear about your complications. I would typically suggest some type of mesh in a revisional surgery such as yours to prevent the bottoming-out that occured. The mesh would create an internal "bra" to provide additional support to the lower breast. Implant revision cases are always challenging, so I highly recommend seeking out a board-certified plastic surgeon that specializes in breast surgery and has extensive experience in revision surgeries. Best of luck in your aesthetic journey.

Hello and thank you for your question. The use of bio absorbable mesh in revision breast surgery depends on the quality of your soft tissue support. Structures that provide support include the breast capsule ( scar tissue around the implant) and the breast skin and subcutaneous fat. Based on your photograph, you have a " double bubble" deformity with descent of the implant below the existing inframammary fold, which is indicative of loss of structural support. Another factor that may be contributing to this would be downward pressure on the implant by your pectorals major muscle. You may benefit from changing planes to a sub glandular or sub fascial location ( if your implants are currently sub muscular) along with repair of your capsule. In these cases, I often have mesh available and make the decision on whether or not to use it based on the structural quality of the capsule during the repair. Good luck. I hope this helps.

Dear aleedo,

bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.

Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.

If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.


Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

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.

It appears that you have essentially complete violation of the natural fold of your right breast. whether mesh is used or not, the fold will need to be reconstructed. Many surgeons will likely encourage you to consider using a mesh product to further reinforce this fold, especially with implants in place. When I discuss mesh with patients, especially those patients who have had multiple surgeries and are unhappy with their results, I use the analogy of an insurance policy. Compared to the cost of another revision surgery, mesh is a cheap insurance policy to decrease the risk of recurrent issues. I then usually have full discussion about the use of ADM vs absorbable mesh like galaflex and their associated cost so that patients can make an informed decision on the costs and risks of a final surgical plan.
Sean FisherSeattle Plastic SurgeonSeattle, WA

If you have some tissue or capsule that can be used for the repair and do not have large heavy implants, mesh is usually not needed for initial repairs.

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.