Bottoming out; do you need a internal bra or will tightening up the ottomans side poles work?

Thank you for your question.  To fix "bottoming out", we use sutures alone to reconstruct the borders of the breast versus an "internal bra", which is typically a type of mesh.  There are obviously different costs associated with one versus the other.  Additionally, the failure or recurrence rate of the bottoming out is typically higher with just the suture repair, but this costs typically less for the patient.  

There are two basic ways to approach a breast implant that has bottomed out.  One way is to tighten the capsule which surround the breast implant at the lower pole of the capsule.  This will raise the bottom of the capsule, a process known as capsulorraphy.  As a double protection on top of a capsulorraphy, one can place Seri.  This process is known as an internal bra.  The extra skin at the bottom of a bottomed out breast implant reattaches itself to the chest wall where it came from.  An external correction of a bottomed out implant directly removes skin that is hanging too low, and therefore corrects the low positioned lower pole of the breast implant pocket.  At times, this is the best and most guaranteed method for correction of bottoming out, but it also leaves an extra scar.  Your personal plastic surgeon is the best resource to help you determine which of these two techniques will work best for your situation.