Bottoming out Correction Post Augmentation Mastopexy-*

Augmentation mastopexy is a fairly complex procedure which entails lifting the breast and reshaping it as well as adding a breast Implant. It is more challenging because the surgeon is simultaneously reducing the skin envelope and increasing its volume. Revision rates of augmentation mastopexy range between 10 and 25% even in the hands of expert surgeons. Patients desiring augmentation mastopexy usually have suffered weight loss and postpartum changes with loosening of the skin and breast tissue. The mastopexy reduces skin and lifts the nipple position and narrows the breast footprint. The augmentation helps to fill the volume especially in the upper part of the breast. This 49-year-old woman underwent augmentation mastopexy with 310 cc silicone gel breast implants placed under the muscle. Over the next few years, she lost weight and noted that the implants began to fall and drift laterally. This is a condition known as implant malposition or bottoming out and is fairly common in augmentation mastopexy. In fact, many surgeons are now utilizing resorbable meshes to help strengthen the tissues in the lower portion of the breasts to prevent this from happening. This patient underwent revisional surgery with placement of an internal absorbable mesh in addition to capsulorrhaphy which is basically an internal seam which achieves narrowing the pocket inferiorly and laterally to help the implant stay in a more superior location.