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

Switching to a smaller implant will help a bit, but is not a necessity. There are several ways to correct bottoming out of an implant:1. removing some or a lot of the capsule and adding texture to the implant2. tightening or plication of the scar tissue capsule (capsulorraphy)3. adding an internal bra (seri, strattice, galaflex)Being your second revision, I would recommend adding one of the internal bra products. Galaflex is the least expensive, has few complications, and very effective; that would be my choice for you. Strattice works great, but is costly. Seri has too many published complications for me to recommend any longer. B 

Hi, I'm afraid reducing your implants by 50-75cc won't be sufficient to minimize a repeat revision. Your tissue has been stretched/injured to the point where it may not hold the repair. I strongly recommend you choose a smaller implant to gain stability. If not, you're risking another revision in the near future. Best, 

"Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant.This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold. Your board-certified plastic surgeon will discuss which approach is best suitable for you based on your current implants.

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.