My skin is stretched and thin.Internal bra or mesh for large implants - will this help to avoid bottoming out or early sagging?

Question

Hello. I am 58 and have breast fed all my children as well as had significant weight loss so all things considered my skin is stretched and thin. I want to have augmentation (possible lift) and go with a large implant (450cc) with high profile. I keep seeing that due to my skin condition and the extra weight of a large implant this may not be advised due to bottoming out or early sagging. I would like to know if I were to get either mesh or an internal bra would that allow me to go with the size implants I am hoping for? I am 5'1" and 135 pounds.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

John L. Burns Jr., MD · Answer

A mesh internal bra would help but with your history even this would lead to bottoming out.  I'd advise a breast lift with a conservative sized implant for the best long term result.

Donovan Rosas, MD · Answer

Mesh can add to device support and mitigate some of the risk of bottoming out/premature descent of the implant. However, this is no guarantee.

It is important to understand that while a mesh adds support, it is ultimately anchored to tissue. Support is only as strong as the weakest link. A strong artificial mesh that is anchored to tissue will eventually relax.

Thus it is a balancing act. Careful implant sizing and external support work in concert to provide a long term result.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Daniel Barrett, MD · Answer

Dear 81818181,

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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

Unfortunately, you have not provided photographs or told us your bra size. 450 cc implants weigh 1 lb. each, will descend inferiorly and laterally and make your situation even worse. The most important thing is the lift. I recommend The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided and nipple sensation (in 95%) is maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

Bioabsorbable mesh can help support those with thin tissue from bottoming out, but it doesn't guarantee it won't happen.  Selecting conservatively sized implants is another way to decrease your risk.  The weight from the implants at times can be too much for the tissues even with mesh support. I've included a video I hope you find helpful.

Mats Hagstrom, MD (license on probation) · Answer

It’s possible to have the fibers of the pectoralis muscle support the weight of the implant against gravity.
It requires that the implant is placed under the Pimas muscle with enough muscle fibers left intact to support the implant. A paragraph part of the pectoralis muscle must be transected in order for the implant to not sit to high when placing the implant under the muscle.
 It’s the surgeon’s ability to leave enough muscle intact to support the implant, and at the same time, allowing the implant to not ride high, which differentiates those who get consistent quality outcomes without complications like implants bottoming out.If the procedure is done correctly, you shouldn’t need mesh or an internal bra.
If the procedure is not done correctly, then you will end up with undesirable side effects and increase the chance of needing revision surgery.
There are three variables to determine breast augmentation outcomes.
The first is patient candidacy.
Without seeing pictures, we can’t begin to make an assessment.
The second variable is implant selection in regards to size shape and type.
 Anytime, excessively large implants are used the chance of undesirable side effects, complications and need for revision surgery will go up.
The bigger, the implant the more likely these problems are.
The problems becomes, especially likely when the implant diameter is significantly wider than the natural diameter of the breast.
The third valuable is the surgeon’s ability to do the procedure correctly. 
In the end, provider selection is the most important variable.
In the hands of the right provider you’ll be guided to make solid decisions and the procedure will be done with minimal chance of needing revision surgery.
Finding the right plastic surgeon is much more difficult than most people realize.
 Most people have very little skill in vetting plastic surgeons.
Generally speaking the Moore consultation someone has the better they’ll be at bedding plastic surgeons.
The more plastic surgeons, you interview the more likely you are to find the better provider for your needs.
I recommend scheduling multiple in person consultations with plastic surgeons in your community.
Bring pictures of yourself to use as reference.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar body characteristics to your own.
Ask each provider to ask what the most common indication for doing revision surgery is, what their revision rate is and what their revision policy is.
Take careful notes during each consultation, especially in regards to the quality and quantity of before, and after pictures shown to you.
Being shown a handful of pictures representing only the very best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider.
It also is unlikely to tell you The number of patients who ended up with undesirable outcomes or needed revision surgery.
When in doubt, slow down and schedule more consultations.
I really do think that having multiple consultations is one of the best ways of assuring a successful long-term outcome.
I do not recommend patients schedule virtual consultations, but instead rely on in person consultations.
Good luck,
Mats Hagstrom MD

My skin is stretched and thin.Internal bra or mesh for large implants - will this help to avoid bottoming out or early sagging?

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