Dr. Jejurikar's Blog

This blog is a synopsis of S03 E53 of the podcast “Three Plastic Surgeons and a Microphone”, featuring Dr. Salvatore Pacella from San Diego, Dr. Sam Rhee from Bergen, New Jersey, and me (Dr. Sam Jejurikar from Dallas, Texas). The episode dives into the transformative concept of internal bras in breast augmentation, discussing their applications, benefits, and real-world outcomes. Let’s explore the highlights from this engaging conversation.


What is an Internal Bra?

The concept of an internal bra involves adding structural support to the breasts using specialized mesh materials during breast augmentation or revision procedures. These meshes act like an invisible bra, supporting the implants and native breast tissue to maintain the desired shape and position over time. Internal bras are particularly effective for combating the effects of gravity and addressing specific concerns such as bottoming out or asymmetry.

The technique typically involves placing a mesh material along the lower pole of the breast, anchoring it to the chest wall, and sometimes to the pectoralis muscle or the existing capsule. The result is a “push-up bra” effect that enhances cleavage, keeps the implant in a higher position, and minimizes lateral movement.


Ideal Candidates for Internal Bras

While internal bras are not necessary for every patient, they are highly beneficial in certain scenarios:

  • Revision Surgeries: Patients with previous implants experiencing bottoming out, asymmetry, or other complications.
  • Poor Tissue Quality: Individuals with stretched or lax breast tissue, often due to massive weight loss, aging, or multiple pregnancies.
  • Desire for Enhanced Support: Patients who want implants to sit higher and closer together for improved cleavage and upper pole fullness.
  • Large Implants: Women opting for larger implants benefit from the added structural support to counteract the additional weight.

For first-time breast augmentation patients with good tissue quality and smaller implants, an internal bra may not be necessary.


Types of Internal Bras

The evolution of internal bras has introduced a variety of materials, each with unique benefits and limitations. Here are the most common types:

1. Biologic Meshes (ADMs)

Biologic meshes, such as Acellular Dermal Matrices (ADMs), are derived from human or animal tissue. They’re highly biocompatible and integrate well with the body’s natural tissue. ADMs are commonly used in reconstructive surgery but can be costly and may not be the first choice for cosmetic procedures unless combined with a lift or addressing capsular contracture.

2. Permanent Meshes

Permanent synthetic meshes, often made of materials like silk, were once popular but are now used sparingly due to potential risks, including infection and prolonged tissue reactions. Patients may experience redness or discoloration at the breast’s surface.

3. Semi-Permanent Meshes

Semi-permanent meshes, such as Poly-4-Hydroxybutyrate (P4HB, trade name GalaFLEX) and Polydioxanone (PDO, trade name Durasorb), are the most commonly used in cosmetic breast surgery today. These meshes provide temporary support while the body heals, promoting stronger capsule formation and improving long-term results.

  • P4HB (GalaFLEX): This mesh dissolves over 6-12 months and leaves behind a capsule that is 2-5 times stronger than natural tissue. It’s ideal for patients requiring extended support during healing.
  • PDO (Durasorb): This mesh dissolves faster, typically within 3 months, making it suitable for patients with thinner tissues or those who want a shorter recovery timeline.

Advantages of Internal Bras

Internal bras provide several benefits that make them a valuable addition to breast augmentation and revision procedures:

  1. Improved Longevity: Mesh materials reinforce the implant pocket, reducing the likelihood of complications like bottoming out or lateral displacement.
  2. Enhanced Aesthetics: Patients achieve better cleavage, upper pole fullness, and implant positioning.
  3. Increased Confidence: Women can go braless without worrying about sagging or loss of shape.
  4. Versatility: Internal bras can be used in primary augmentations, revisions, or even with mastopexies (breast lifts).

Surgical Techniques for Internal Bras

The placement of an internal bra varies depending on the patient’s anatomy, goals, and the surgeon’s preferences. Here’s an overview of the technique:

  1. Preparation: The mesh is trimmed and shaped to fit the patient’s anatomy. For revisions, any scar tissue or capsules are addressed first.
  2. Anchor Points: The mesh is anchored to the chest wall, pectoralis muscle, or existing capsule, creating a hammock-like support structure.
  3. Implant Placement: The implant is then positioned within the pocket, and the mesh provides additional reinforcement to maintain the desired shape and position.
  4. Customization: Mesh placement can be adjusted to achieve specific goals, such as pushing implants closer together or elevating their position.

Addressing Challenges with Internal Bras

While internal bras offer many benefits, there are challenges:

  1. Cost: The addition of mesh increases the overall expense of surgery.
  2. Temporary Awareness: Patients may feel the mesh during the healing process, particularly with longer-lasting materials.
  3. Waterfall Deformity: This occurs when breast tissue sags over the implant, requiring additional interventions such as skin tightening or minor revisions.

Learn More from the Experts

For a deeper dive into internal bras in breast augmentation, check out S03 E53 of the podcast “Three Plastic Surgeons and a Microphone”, featuring Dr. Salvatore Pacella, Dr. Sam Rhee, and Dr. Sam Jejurikar. The episode explores the nuances of this revolutionary technique, including ideal candidates, mesh types, and real-world outcomes. [Insert link here]


Conclusion

Internal bras have redefined the possibilities in breast augmentation, providing structural support that enhances both aesthetics and longevity. Whether used for primary augmentation, revisions, or complex cases, they empower patients to achieve their desired look with greater confidence.

If you’re considering breast augmentation or revision and are curious about the benefits of an internal bra, schedule a consultation with a board-certified plastic surgeon to discuss your options.

Call (214) 827-2814 to book your consultation today. Transform your vision into reality with advanced techniques tailored to you.

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