Breast surgery is a popular choice for people who want to change the look of their breasts, whether it’s to make them bigger, smaller, or lifted. These surgeries have helped many people feel more confident about their appearance. But, like anything else, the results can change over time because of aging, weight changes, or gravity.
To prolong the results, plastic surgeons have introduced a new technique: using a surgical mesh inside the breast, like an internal bra. This mesh is supposed to support the breast tissue, helping it stay in place and keep the desired shape for a longer time.
As this idea becomes more popular, it’s important to take a closer look at what this surgical mesh does. Is it the solution many believe it to be, or are there things we need to consider before deciding if it’s the best option? In this blog post, we’ll explore how surgical mesh is used in breast surgery, what the benefits are, and what the potential downsides might be. Whether you’re thinking about breast surgery yourself or just want to learn more about this new technique, this post will help you understand the whole picture.
Quick Summary
- Internal Bra Concept: The internal bra involves placing a mesh inside the breast, like a hammock. This hammock is placed under the skin and fat but outside the breast tissue. The mesh is meant to act like a sling, holding the breast tissue in a higher position. It’s like a bra, but inside the breast instead of outside, to help keep the breast’s shape over time and reduce sagging.
- Potential Benefits: The mesh might help keep the breast shape, reduce sagging, make the results more predictable, and improve fullness in the upper part of the breast, although results can vary.
- Risks and Considerations: There are risks like infection, the mesh moving or breaking down, and we don’t fully know the long-term effects.
- Added Cost of Mesh: Using mesh can make the surgery a lot more expensive, adding thousands of dollars to the total cost.
- Galaflex Mesh: Galaflex is currently the most popular type of mesh and is designed to dissolve over 12 to 18 months. It gives early support but raises questions about how well it works in the long run.
Our Recommendations: Very few studies have been published on internal mesh bras and none describe long-term results. Before and after photos on the internet also show results that look the same as regular breast lifts. We don’t recommend the internal mesh bra for most routine breast lifts and reductions because of it’s unproven results, high expense, and potential risks. We do sometimes recommend it for breast lift revisions where other methods have not worked.
Understanding Surgical Mesh
Before we discuss how surgical mesh is used as an internal bra, it’s important to understand what surgical mesh is. Surgical mesh is a special material that doctors use in different surgeries to support weak or damaged tissue. There are different types of mesh, and understanding them helps us see how they might work in breast surgery.
Types of Mesh Materials:
- Synthetic Mesh: Synthetic mesh is made from man-made materials like plastic. One of the most common types is made from polypropylene. This kind of mesh is strong and provides good support, but since it’s a foreign material, there’s a risk that the body could react to it, which might cause problems like infection or the mesh breaking down over time.
- Biological Mesh: Biological mesh is made from natural materials, usually animal or human tissue. The tissue is treated to make it safe for use in the body. An example is acellular dermal matrix (ADM), which comes from human donor skin with the cells removed. Biological mesh often works better with the body’s tissue, reducing the chances of rejection or other problems. However, it can be more expensive, and how long it lasts can vary.
- Absorbable vs. Non-Absorbable Mesh: Mesh can also be either absorbable or non-absorbable. Absorbable mesh is designed to dissolve in the body over time, leaving behind scar tissue that continues to provide support. This kind of mesh might cause fewer long-term problems, but the scar tissue it leaves might feel or look different from normal tissue. Non-absorbable mesh is meant to stay in the body permanently, giving ongoing support, but it could cause issues if complications happen, like needing to be removed later
Galaflex: A Popular Choice
One of the most popular meshes used in breast surgery today is Galaflex. Galaflex is an absorbable mesh made from poly-4-hydroxybutyrate (P4HB). This mesh is designed to dissolve over time, usually within 12 to 18 months. As it dissolves, the patient’s own scar tissue replaces it, keeping the breast supported.
Galaflex is often chosen because it gives strong support during the early stages of healing, helping the breasts keep their shape and position. Since it dissolves, it reduces the long-term risks that can come with permanent synthetic meshes, like ongoing reactions from the body. However, because Galaflex eventually goes away, some wonder if its support will be enough once the mesh is gone.
Knowing about the different types of mesh materials, including popular ones like Galaflex, is important because each works with the body differently. The type of mesh used can affect the results of the surgery, the risks, and how well things turn out in the long run.
In the next sections, we’ll discuss how the internal bra concept works, what it promises, and whether it lives up to expectations.
The Internal Bra Concept
The “internal bra” is a concept where an additional support system (permanent or temporary) is placed inside the breast using surgical mesh. This mesh acts like an invisible bra, holding the breast tissue in place from the inside instead of relying on an external bra for support.
During surgery, the mesh is placed under the breast tissue and attached to the chest wall or other strong parts of the breast. This creates an internal scaffolding that helps keep the breasts in shape and position over time. For patients worried about sagging after a breast lift or augmentation, the internal bra is promoted as a solution that could keep their results looking good for longer.
On the surface, the internal bra idea seems like a big improvement, offering extra support that might delay aging or other changes. But since this technique is still new in cosmetic surgery, there’s a lot we don’t know about how well it works in the long run and whether it offers the benefits that some people claim.
In the next sections, we’ll look at how the procedure is done, the benefits often discussed, and the risks that may not always be fully discussed. This will help us understand whether the internal bra lives up to its promises or if it’s something that’s being overhyped.
Procedure Details
Understanding how the internal bra procedure is done can help you decide if it’s the right choice for you. The procedure starts with the patient under anesthesia, just like other breast surgeries. To insert the surgical mesh, the lower part of the breast—from the nipple to the crease and from side to side—must be fully exposed. This usually means making full anchor scar incisions, which include cutting around the areola, vertically from the areola to the breast crease, and along the crease.
In some cases, the internal bra technique can be done with vertical (lollipop) mastopexies, which require fewer incisions. However, this needs extra dissection, which can affect the contour of the breast tissue and its natural support structures.
Once the lower part of the breast is exposed, the surgeon places the mesh inside the breast, under the breast tissue. The mesh is attached to strong areas inside the chest, like the chest wall or muscles. This attachment is important because it helps the mesh provide the support needed to keep the breast tissue in place.
The mesh is meant to integrate with the body over time, sometimes becoming surrounded by the patient’s tissue, which can make it more stable. The surgeon carefully adjusts the mesh to create the desired shape and support before closing the incisions.
While the procedure may sound simple, it adds more complexity. The success of the internal bra depends a lot on the surgeon’s skill and experience. The use of surgical mesh also makes the surgery longer and more complicated, and it can increase the risk of complications.
After the surgery, patients usually go through a recovery period similar to other breast surgeries. However, the mesh can make recovery longer or more involved. It’s also important to be aware of possible complications, like infection, when introducing a foreign material into the body.
In the next section, we’ll discuss the benefits often mentioned when using surgical mesh and some potential downsides that might not be obvious.
Advantages of Using Surgical Mesh
Using surgical mesh in breast surgery is often talked about as a way to make the results last longer. People who support this technique say it has several benefits that can be very appealing to those who want to keep their breasts looking good over time.
One of the main benefits is that the mesh might help the breasts keep their shape better. As time goes on, things like aging, gravity, and changes in weight can cause the breasts to sag or lose their shape. The idea behind the internal bra is that it gives extra support inside the breast, helping it stay lifted and fuller for longer.
Another benefit that is often mentioned is that the mesh might reduce the risk of the breasts sagging again after surgery. For people who have had a breast lift, there’s sometimes a worry that the sagging will come back. The mesh is designed to hold the breast tissue in place, which could prevent the need for more surgeries later.
Some doctors also believe that mesh can help them achieve more predictable results. By providing a stable support system inside the breast, the mesh might help the surgeon create the exact shape they want and maintain that shape over time.
Another proposed benefit is greater upper pole fullness. The upper pole refers to the part of the breast above the nipple. This area can sometimes lose fullness over time, especially after pregnancy, weight loss, or as a natural part of aging. This can make the breasts look less perky or more deflated. The idea behind using mesh is that it provides extra support to the lower part of the breast, which in turn helps push the upper breast tissue higher and hold it in place. By supporting the lower breast tissue, the mesh helps to lift and maintain the fullness of the upper pole, giving the breasts a more youthful and rounded appearance.
While these benefits sound good, it’s important to remember that results can be different for each person. Also, just because an idea seems good in theory doesn’t mean it necessarily works in the real world.
In the next section, we’ll look at the risks and things to think about when using surgical mesh. You need to know this if you’re considering internal bra surgery.
Risks and Considerations
While there are some potential benefits to using surgical mesh in breast surgery, it’s also important to be aware of the risks before deciding on this option.
One of the main risks is infection. Because surgical mesh is a foreign material, the body could react to it, leading to an infection. This infection can sometimes be serious enough to require removing the mesh, which could mean additional surgeries and a longer recovery time.
Another concern is the possibility of the mesh eroding or moving over time. If the mesh doesn’t stay in place or wears down, it might not provide the support it’s supposed to. This could lead to the very problems it was meant to prevent, like sagging or changes in the shape of the breast. In some cases, the mesh could cause discomfort or pain if it shifts or puts pressure on surrounding tissues.
There’s also the issue of how the mesh interacts with the body over time. While some meshes are designed to be absorbed by the body, others are meant to stay in place permanently. It’s not always clear how these materials will behave in the long term, especially since the use of mesh in cosmetic breast surgery is still relatively new. There could be unknown risks that might only become apparent years after the surgery.
Another significant consideration is the cost of the surgical mesh. The mesh itself can be quite expensive, often adding thousands of dollars to the overall cost of the surgery. Depending on the type of mesh used and the complexity of the procedure, patients might see an increase in their total surgery bill ranging from $3,000 to $10,000 or more. For many patients, this cost can be a major factor in deciding whether the potential benefits of the mesh are worth the financial investment.
Additionally, not everyone is a good candidate for an internal bra. Factors like the patient’s skin quality, overall health, and the specific goals of the surgery all play a role in whether the mesh will be effective. Patients need to have a thorough discussion with their surgeon about these factors to make sure they’re making the best choice for their situation.
In the next section, we’ll compare the internal bra technique to more traditional methods of breast surgery to see how they stack up against each other.
Comparing Techniques
When considering the internal bra technique with surgical mesh, it’s important to compare it to more traditional methods of breast surgery, like breast lifts (mastopexy) and augmentations with implants. Understanding how these different approaches stack up can help you decide which option might be best for you.
Traditional Breast Lift (Mastopexy)
In a standard breast lift, the surgeon removes excess skin and reshapes the breast tissue to lift and firm the breasts. This method doesn’t involve any foreign materials like mesh; instead, it relies on the natural tissue to support the new shape. The results can be very effective but depend somewhat on the patient’s skin quality and tissue elasticity. Over time, the effects of gravity, aging, and other factors can cause the breasts to sag again, sometimes requiring additional procedures.
Women who need moderate lifts or breast reductions (ie most patients) usually get the prettiest results with a vertical (lollipop) breast lift. The vertical lift produces less scarring and rounder, fuller, more projecting breasts than the more common anchor scar technique. Unfortunately, surgical mesh placement usually requires an anchor scar lift.
Breast Augmentation with Implants
Breast augmentation involves placing implants (usually silicone or saline) behind the breast tissue or under the chest muscles to increase size and improve shape. Implants can provide a fuller, more youthful appearance and help correct sagging to some extent. However, implants don’t prevent future sagging, and they may need to be replaced over time due to issues like implant rupture or capsular contracture (where scar tissue hardens around the implant).
Breast implants remain the gold standard for women who want to add fullness to their upper breasts. Modern cohesive gel (gummy bear) breast implants can even increase upper fullness without making the overall breast much larger if that’s your goal.
To date, we have seen no internal mesh bra results (published or on the web) that show upper breast fullness that’s even close to what can be achieved with breast implants.
In the next section, we’ll look at what patients can expect during recovery and how they might experience the results of these different techniques over time.
Patient Experience
When deciding on breast surgery, it’s important to understand what the recovery process will be like and what you can expect as a patient. Whether you choose a traditional breast lift, augmentation with implants, or the internal bra technique with surgical mesh, each option comes with its own recovery timeline and experience.
Recovery After a Traditional Breast Lift
After a traditional breast lift, patients can expect some soreness, swelling, and bruising around the breasts. The first few days after surgery are usually the most uncomfortable, but pain can be managed with medication prescribed by the surgeon. Most patients can return to light activities within a week or two. Still, it’s important to avoid heavy lifting and strenuous exercise for several weeks to allow the body to heal properly.
Scarring is another consideration. While the scars from a breast lift usually fade over time, they will be permanent. Plastic surgeons typically place the incisions in less visible areas, like around the areola or under the breast, but it’s important to have realistic expectations about scarring.
Recovery After Breast Augmentation with Implants
Recovery from breast augmentation with implants is similar to that of a breast lift, with some additional considerations. Patients may experience tightness in the chest area as the body adjusts to the implants. Like with a lift, there will be swelling, bruising, and discomfort, which can be managed with pain medication.
Recovery After an Internal Bra with Surgical Mesh
The recovery process for the internal bra technique can be more complex than traditional breast lifts or augmentations. Because the surgery involves placing and securing mesh inside the breast, patients might experience more swelling and discomfort as the body adapts to the foreign material. The recovery period might also be longer due to the additional complexity of the surgery.
The presence of the mesh near the surface of the breast can sometimes feel unnaturally stiff and may create an irregular contour, especially in the beginning. If the mesh is permanent, these issues could be long-lasting. If the mesh is designed to dissolve over time, the scar tissue that forms in its place might also feel or look unnatural, leading to similar concerns.
Patients might need extra precautions during recovery to ensure the mesh integrates well with their body. This could include wearing a support garment for a longer period and attending more follow-up visits with the surgeon to monitor the healing process. There is also the added consideration of watching for signs of infection or complications related to the mesh, which could extend the recovery time if they occur.
In the next section, we’ll look at where the use of surgical mesh in cosmetic breast surgery might be headed.
Future of Surgical Mesh in Cosmetic Surgery
Using surgical mesh as an internal bra in breast surgery is still pretty new, and its future will depend on more research, patient experiences, and advances in technology. As more people get this procedure and learn more about it, we’ll have a clearer idea of how well it works and what problems might arise.
Improved Materials and Technology
One area that might improve is the materials used for the mesh. As technology improves, we may see new types of mesh that work more smoothly with the body, lowering the chances of problems like infection, mesh erosion, or stiffness. New meshes might dissolve over time, leaving less noticeable scar tissue or materials that feel more like natural tissue.
Long-Term Studies
As more people choose the internal bra technique, long-term studies will be key to determining if it gives better results than traditional methods and how well those results last over time. We need a lot more data to know if breast lift results are improved by using mesh. Even if the results look good initially, it’s important to find out if they stay that way in the long run and for how long. Another big question is how different mesh materials interact with breast tissue over time. We need long-term data to see if these materials are truly safe or if they might cause problems down the road. This information will be crucial for patients and surgeons when deciding if this technique is worth the extra cost, complexity, and potential risks.
Our Recommendations for the Use of Internal Mesh Bras
When deciding whether to use internal mesh bras in breast surgery, we should focus on three questions:
1. Does It Work? First, we need to know if the mesh actually works. Does it help keep the breast shape longer and stop the bottom of the breast from stretching out? And does it make the upper part of the breast fuller than surgery without mesh?
2. Is It Worth the Cost? Next, we have to consider the cost. Is the extra money spent on using mesh worth the benefits it provides? This includes not just the cost of the mesh itself but also any extra costs, like longer surgery times or the possibility of needing more surgeries later.
3. Is It Safe? Finally, safety is very important. We must look at short-term safety—how well patients do during and right after surgery—and long-term safety. Are there risks like infection or the mesh breaking down over time? Over the long term, does surgical mesh affect breast health? Do these risks outweigh the benefits?
Does It Work?
Unfortunately, there isn’t much evidence to show that using surgical mesh, whether it’s permanent or absorbable, really helps breast lift patients. This conclusion comes from four main sources.
The first source is the published studies on mesh bras. There aren’t many studies on mesh bras, and the existing ones have some big limitations. Many of these studies only look at results shortly after surgery. This makes it hard to know if the mesh helps keep the breast shape over a longer period.
Another problem is how these studies are designed. None of them include a good control group—patients who had the same surgery but without the mesh. Without this comparison, it’s hard to say if any benefits seen are actually because of the mesh or just because of the breast lift itself. Also, most of these studies include only a few patients, making it difficult to trust the results.
In simple terms, while some studies suggest that mesh might help keep the breast shape or make the upper part of the breast fuller shortly after surgery, we don’t have enough long-term data, good comparisons, or large enough studies to be sure that the mesh is truly making a difference.
The second source of information comes from results posted on the internet. While this isn’t a scientific analysis of every mesh bra result, we have intentionally looked at many websites to get a sense of the outcomes. One thing that stands out is that not many plastic surgeons who offer the mesh bra actually post pictures of the results using it. In many cases, it’s also unclear whether the breast lift results shown were obtained with or without the use of mesh, so there aren’t a lot of clear examples to analyze.
Among the results we’ve reviewed, there doesn’t seem to be a significant difference between the outcomes of breast lifts performed with mesh and those done without it. Specifically, we haven’t found any results that show a noticeable improvement in breast shape or upper pole fullness when mesh is used. Additionally, we couldn’t find any posted long-term results photographed more than a year after surgery.
The third source is feedback from surgeons who have used internal mesh bras in their work. Many plastic surgeons say they see good results at first. But many are sceptical about how well the mesh works in the long run. Over time, surgeons have noticed that the differences between breast lifts with mesh and those without it become harder to see, and some say the results end up looking the same after a few months.
Some surgeons have also noted that problems like infection or the body rejecting the mesh can cancel out any short-term benefits the mesh might provide. Since we don’t have strong, long-term evidence, this suggests that while using mesh might sound like a good idea, the real long-term benefits are still unclear.
The fourth source is our personal experience with using various meshes in breast surgery. Over the years, we’ve tried different meshes, and our experience echoes what we’ve seen in the literature and heard from other surgeons. Namely, if the internal mesh does yield improved results, those improvements are inconsistent and tend to be small. Furthermore, there are real questions about whether these results hold up over the long term. Like others, we’ve seen cases where any initial benefits seem to disappear over time, leading us to question whether using mesh is worthwhile in most cases.
Is It Worth the Cost?
When deciding whether to use internal mesh bras in breast surgery, it’s important to consider the cost. The question is not just whether the mesh works but also whether it’s worth the extra money.
Cost of the Mesh:
The first cost to consider is the price of the mesh itself. High-quality mesh used in breast surgeries can be very expensive. Depending on the type of mesh—whether it dissolves over time or stays in the body—the cost can range from a few hundred to several thousand dollars. This cost usually gets passed on to the patient, making the surgery more expensive.
Extra Costs During Surgery:
Using mesh can also make the surgery more complicated, which might mean it takes longer. A longer surgery often means using more resources, like more time in the operating room and more anesthesia. All of these things can add to the total cost of the surgery.
Total Additional Costs:
Let's break it down to give you an idea of the extra costs. If you’re using Galaflex mesh, which is the most popular mesh for this purpose right now, the cost of the mesh itself is typically between $2,000 and $3,000. We’ll assume it costs around $2,500. Also, using mesh can add about an hour and a half to the surgery, which could cost roughly $4,000 more. So, in total, you might expect to pay about $6,500 more for a mesh internal bra lift compared to a regular breast lift.
Is It Safe?
Safety is one of the most important considerations when considering using internal mesh bras in breast surgery. The safety of using mesh involves both short-term and long-term risks, and it’s important to weigh these against the possible benefits.
Short-Term Safety
In the short term, the main worries are how the body reacts to the mesh right after surgery. Risks include infection, inflammation, or the body rejecting the mesh. These problems can happen soon after surgery and might need extra treatments, like antibiotics or, in serious cases, surgery to remove the mesh. Although these issues don’t happen often, they can be serious if they do.
Long-Term Safety
Long-term safety is another big concern. Even though some meshes have been around for a long time, they were only recently used for internal bras. This means we don’t know how these meshes interact with breast tissue over the long term.
The mesh that’s most commonly used right now is called Galaflex. It was first approved by the FDA in 2007, but that was for use as a suture material, not as a mesh in the breast. Using Galaflex as a mesh in breast surgery wasn’t described until 2017. Galaflex is supposed to break down into carbon dioxide and water, which the body can naturally eliminate. However, no long-term or large studies look at how Galaflex works in breast tissue. Because of this, we don’t know if it’s truly safe to use in the breasts or if there could be problems down the road.
Long-term risks for meshes that don’t dissolve include ongoing inflammation, the mesh wearing through the surrounding tissue, and a possible need to remove the mesh if it causes problems. These risks must be carefully considered, especially since the benefits of using mesh aren’t clear or guaranteed.
Impact on Future Surgeries
Another thing to weigh is how the mesh might affect future surgeries. If there are complications from the mesh or if the patient needs more surgeries later, having the mesh—or what’s left of it—can make future surgeries more complicated. This is especially important for patients who might need more cosmetic surgeries.
Recommendation on Internal Surgical Mesh Bras
Let’s sum up the answers to our three questions:
- Does it work?
- If it works, is the price fair for what it does?
- And, if it works and the price is fair, is it safe for our patients?
With internal mesh bras, we hit problems right from the first question.
There isn’t much evidence that today’s internal mesh bras improve breast lift results. These mesh bras don’t seem to create more fullness in the upper part of the breast, even during the early healing stages, compared to lifts without mesh. There’s no proof that breast lifts with internal mesh bras last longer or maintain their shape better over time than standard breast lifts.
We could stop here, but let's look at the other two questions anyway. With the small and uncertain improvements that might come from using mesh bras, it doesn’t seem worth spending thousands of dollars to add mesh to your breast lift. Using mesh also brings extra risks, and we don’t know if it’s safe in the long run.
Because of these concerns, we only use mesh in complex cases, such as salvaging botched breast surgeries where other techniques have failed. We do not recommend internal mesh bras to our patients undergoing straightforward breast lifts and reductions. For women who want more fullness in their upper breasts, we still recommend breast implants because they are reliable and predictable.
