BACKGROUND: Bilateral breast augmentation has been the top surgical procedure performed worldwide by plastic surgeons for the past 5 years. Complex breast revision patients are challenging, with the cleavage area being one of the most difficult areas to navigate. We present a novel technique for using biological scaffolds in revision breast augmentation surgery. METHODS: A step-by-step surgical technique is presented, combined with a series of 11 cases where either SurgiMend® acellular dermal matrix (ADM) or GalaFLEX mesh was used specifically in the medial cleavage area to correct a difficult to manage soft tissue contour deformity. RESULTS: Eleven patients underwent revision breast augmentation with the use of the biological scaffolds in the medial cleavage area. The mean age was 43 years with a range of 29-68 years. All replacement breast implants were anatomical-shaped, medium profile, polyurethane-coated implants. GalaFLEX® mesh was used in six patients; five patients received SurgiMend® ADM. Mastopexy was performed in 8/11 patients. There were two complications in the same patient in this series, one emergency return to theater for bleeding and one minor scar revision. CONCLUSIONS: Revision breast augmentation surgery includes a smorgasbord of options that can be used individually or in combination, such as full or partial capsulectomy, removal alone or replacement of the implant, change to the tissue plane of where the implant sits, mastopexy, and fat transfer. In addition to these recognized treatments, we would like to advocate the option of a biological scaffold for extra support of the cleavage area in complex revision cases.