Using Strattice As Preemptive Measure Against Bottoming out in Lift + Augmentation?

Have had three consultations and most recent PS who specializes in reconstructive surgery advised that my skin tissue is somewhat thinner than ideal and thinks that implants could easily bottom out within a year of a lift + augmentation. He suggested considering using Strattice to prevent skin from over stretching. I am 30, 5'5', 160 lbs, run daily so an internal reinforcement is of interest to me. prev 36DD now a small C, seeking full D. also getting full TT and lipo of flanks. Thanks!

Doctor Answers 16

Can Bottoming Out Be Prevented with "Strattice"?

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Strattice and Alloderm are brands of material that can be used in breast reconstruction to provide  coverage and support to breast implants.  This material, called ADM (acellular dermal matrix), can also used in fine tuning an aesthetic breast augmentation that requires added support or coveraget.  It is not common to use it in an initial breast surgery.  Its use is limited by its extremely  high expense. If cost did not matter plastic surgeons would use this frequently. It is certainly safe  for a primary  augmentation. Your photos do not make you appear to be at high risk for bottoming out so if you use it and get a good result you will never be sure that it was because of the Strattice.   

Seattle Plastic Surgeon
4.9 out of 5 stars 117 reviews

Using Strattice As Preemptive Measure Against Bottoming out in Lift + Augmentation?

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This question has stirred many responses. Thanks for posting photos. From my view I would be more concerned about obtaining a large enough implant with a full mastopexy lift to end up a D cup. Bottoming out is more a secondary issue. If you want a higher % of avoiding this issue than you should spend the extra $2,000 or $3,000 to use an acellular dermal matrix. I might suggest a staged breast operation. Do the full mastopexy first, allow 3 months of healing than insert a 400 cc + implant with or with out the matrix in a second operation. Just another option. 

Using Strattice As Preemptive Measure Against Bottoming out in Lift + Augmentation?Answer:

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I feel lift patients need support, either from complete submuscular placement if the pt. desires no larger than a small-mid C or Strattice if she desires larger (LifeCell does not “recommend” Alloderm in cosmetic cases) sutured from the pec down to the chest wall. My experience is that any muscle release to try & accommodate a larger implant will drop, and the patient will lose upper fullness. So in larger lifts, I feel Strattice is a must. Expensive yes but cheaper than a re-do.


John J. Corey, MD
Phoenix Plastic Surgeon
4.7 out of 5 stars 48 reviews

Strattice for Mastopexy Augmentation

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I have used Strattice in a number of mastopexy augmentations (as well as for capsular contracture and other revisionary breast surgeries). I also have given courses and am a speaker for Lifecell (the company that makes Strattice) - but these views are mine alone.

You mentioned risk of bottomming out that concerns you. Bottomming out is when the fold is displaced to a lower position. This is a rare issue with mastopexy augmentations. The real problem is one of inferior stretch in which the fold stays at the correct level but the skin and tissue underneath it from the nipple to the fold stretch. This happens when the skin quality is poor. Strattice can help in these cases and does not really stretch that much. it does add to the cost but can be helpful in the right situation of poor skin quality.

The other issue i would consider more important is whether to have a mastopexy augmentation, tummy tuck and liposuction in one stage. Operative time is lengthy, quality of surgery often decreases and complications such as blood clot risk rise with multiple procedures.

Jason Pozner, MD
Boca Raton Plastic Surgeon
4.7 out of 5 stars 46 reviews

Using Strattice in first operation

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I have also thought about using Strattice in first time patients at high risk for implant malposition.  This would be very expensive though.  While I can't say for sure because I have not examined you, you look like your inframammary creases are well defined and these are the best barrier to implant descent.  Don't go too big, do wear a well supportive bra 24/7 for at lease 3 months and don't do exercises that bounce the implants too much or use too much pec strength during those 3 months.  I'd try to do it without the Strattice probably.

Bottoming out and the use of Strattice

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Placing implants during a breast lift should provide you with good volume and good breast shape.  I have not yet had to use any supporting membranes for a primary breast surgery.  If the ligaments that support the breast crease are cut, such as during a mastectomy for cancer, then membrane support can be helpful.

As long as the inframammary fold is not injured during surgery additional fold support with Strattice should not be needed.

Strattice as routine with breast implants

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The fact is that bottoming out of breast implants is quite uncommon, and even for capsular contracture Strattice and other allografts are very expensive, and will not always work. Your tissue does not look particularly thin and we would suggest you forgo the Strattice and have the implants without.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Breast lift, bottoming out

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Although Strattice or any of the other similar skin products may help, it is quite expensive and doesn't always work. I have found in my patients with thinner skin that need a lift and augmentation, it often works well to             2-stage the procedure. We do a "vest over pants" type of lift to double the thickness of your own skin, then wait 3-6 months before putting in implants. This not only reduces the risk of wound healing issues from poor blood supply due to the tight lift and pressure from the implants, it also allows your wound to fully heal and gain strength before the pressure of the implants and reduces the bottoming out risk you are rightly worried about.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews


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Bottoming out is a relatively uncommon event following Breast Augmentation.  Strattice is a nice tool to be used in reconstructive breast surgery and revison surgery following breast augmentation.  It is not commonly used as a preventive measure in primary Breast Augmentation.  It will add significantly to the overall cost.  Therefore, I would not recommend its use in your situation.

Todd B. Koch, MD
Buffalo Plastic Surgeon
4.6 out of 5 stars 37 reviews

Stratice to prevent bottoming out.

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Some bottoming out will occurr with larger implants over time if the proper support (bra) is not worn.  Strattice or other types of acellular dermal matrix products may help for some individuals.  It is important to remember that:

1) This is also skin product and will also stretch

2) It is not cheap

3) If a circumvertical lift is done, a small revision down the road under local anesthesia to retighten the breast is easy to do.

I say go without the strattice and have the pocket properly performed as well as the lift.  Wear a bra consistently and just get a small revision lift down the road if and when you need it.

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.