One side bottomed out. Should I add mesh to 1 or both breasts during revision surgery?

That's always a tricky question when one breast is fine and the other needs work because you risk developing an infection (albeit a less than 1% chance), by operating on a breast without problems, so you want to make sure you are 100% certain it is worth doing.

What would sway me in advising a patient would be the quality of the tissue of the non-bottomed out breast. If I thought there was a high chance that in time this breast would also bottom out then I would put mesh in both breasts. If I thought it was unlikely than I wouldn't take the small risk of an infection in the non-bottomed out breast.

I will say in my experience it is not very common just to have one breast that bottoms out because the tissue of the two breasts is usually the same and it is the weakness of that tissue that is responsible for the bottoming out.

I’ve done many breast revisions through the years. Whenever I attempted to fix just one side, other than very simple implant position lowering operations, bilateral surgery always gave the better results.

The most important variable in treating a bottom doubt implant is provider selection.
These can be corrected using internal sutures, only or in a combination with adding mesh or cadaver durable products like “Aloderm”.
What technique used is not nearly as important as who does the repair.
To some degree how the primary procedure was performed is also an indicator of the chance of success with correcting this deformity.
You should vet your provider thoroughly to make sure they have a solid track record for correcting bottom out implants.
A good plastic surgeon shouldn’t have bottomed out implants in the first place.
Ask providers to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar situations.
Bring pictures of yourself to use as reference during second opinion consultations.
For second opinion at consultations, you should also come prepared to bring it with you a complete set of proper before and after pictures and a copy of your operative report.
These are part of your medical record that you can request from your provider. Who did your initial procedure.
Best,
Mats Hagstrom MD