Mesh to correct bottoming out - Good or bad?

Question

Is it good or bad to use a mesh for lift up and to correct bottom out issue ? Some doctors told it’s a foreign body and not good Any Doctor advice me

Ajaya Kashyap, MD · Answer

Thank you for your query. The opinions on this are divided, but in some firm stances a mesh may be quite helpful depending on the breast tissues and condition of the skin. Most of the time, however, a mesh may not be required and would add to the costs and occasional side effects. Please find an experienced, board certified Plastic surgeon who can examine you and help you with all your concerns. All the best!

Gary M. Horndeski, MD · Answer

I do not use mesh for bottoming out because I do not believe it has the mechanical strength. You may be better off with removal the implants and doing a lift or replacing with smaller implants or fat transfers. Unfortunately, you have not provided photographs or told us your bra size. I would need more information to give you a more accurate answer.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Terrific677088,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Milan Doshi, MS, MCh · Answer

Hi Terrific677088Mesh (or ADM/internal bra) is not inherently good or bad&mdash;it is a tool used in selected cases where tissue support is weak, recurrent bottoming out has occurred, or additional reinforcement is needed. It can help stabilize the implant position and reduce recurrence, but it is still a foreign material, with considerations like cost, infection risk (low but present), and integration variability.
Importantly, mesh is not a substitute for proper surgical technique.
A key part of correction is surgical fixation and reconstruction of the inframammary fold (IMF):
IMF fixation (capsulorrhaphy) re-establishes the correct fold positionControls implant pocket and prevents downward migrationIs often the primary step in correcting bottoming out
In many cases:
IMF repair alone may be sufficient if tissues are reasonableMesh is added when extra support is needed, especially in thin or previously stretched tissues
The best outcomes usually come from a combination of correct pocket repair + appropriate implant size + (if needed) mesh support, not mesh alone.
This is a great question. I would recommend consulting with a board-certified plastic surgeon to further discuss your goals and evaluate you in person.

Connie Hiers, MD, FACS · Answer

Mesh can be very helpful if used correctly. the mesh I use is not permanent, but allows your own tissue to grow into it and replace it. Do remember, your implant is a "foreign body" too. You also may need to go with something smaller and less heavy,

Mesh to correct bottoming out - Good or bad?

Answers (5)

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