Can’t I possibly get an internal bra placed without replacing my implants?

Question

My right breast has been bottoming out since fresh out of surgery Nov2017 and without doing research I ended up exchanging my implants June2018 because I didn’t know much about bottoming out I simply didn’t like the size of my breast and wanted them bigger. Now that I know for sure what’s wrong I’ve been previously told I need an internal bra. Previous post has pictures. I really want to get my self esteem back but don’t want to make anymore mistakes. Please help! With pricing and consult?

S. Larry Schlesinger, MD, FACS · Answer

The short answer to your question is NO.  Once implants are touched, they should be replaced.  Let me explain.The day you were born, your skin was covered with bacteria which does not cause disease or injure you in any way.  These bacteria are often called non-pathogenic bacteria.  The minute the surgeon's sterile gloves touch the skin, it picks up these bacteria,  The process of creating an internal hammock through any approach requires touching the implant, and very often removing it and putting it back into the implant pocket.  This amount of touching the pocket and the skin causes a great deal of non-pathogenic bacteria to live in the implant pocket or on the implant.Because one's immune system reads these bacteria as an invader, it significantly increases the chance of a hard breast, i.e. capsular contracture.  Since this will be the 3rd surgery on your breast, I highly recommend you get new sterile implants placed in the pocket using a Keller funnel to significantly decrease the chance of a capsular contracture.The material that creates the hammock is, at times, breast capsule plus an ADM of one kind or another.  The most commonly utilized ADM for a hammock or internal bra is Strattice, and the most common route of entry to accomplish this repair is a periareolar incision.  One little trick that I have found useful when the circumference of a nipple is too small to accomplish this somewhat tricky surgery, I just have my tattoo artist increase the dimension of the areola and then make my incision at the edge of the new nipple areolar complex.  The money saved by no placing new sterile implants in the breast pocket will pale in comparison to the cost of a revision surgery because of a capsular contracture.

Urmen Desai, MD, MPH, FACS · Answer

I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Daniel Barrett, MD · Answer

Dear SanJoseGirl,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

Connie Hiers, MD, FACS · Answer

Since your implants have bottomed out twice, you need to go smaller. The first implant was too heavy for your tissue to support. A larger implant is still too heavy. Now with stretched tissue, you may need mesh for support, but do need to go down in size.

Jason Pozner, MD · Answer

I often will place an internal mesh bra, usually Galaflex, using the patients existing implants. This is usually done in situations like yours in which the previously placed implants were recent. Pricing depends on ampunt of work that needs to be done and estimated surgical time. At this time I dont have access to your original posted photos.

Jon Ver Halen, MD, FACS (license suspended) · Answer

Dear San Jose Girl,Hello and thank you for your excellent question. You have a few options, based on your photos. One is to have a breast lift revision with an internal bra. A second is to have an implant removal and No-Vertical-Scar, No-Implant breast lift technique. There are a number of no-vertical scar breast lift techniques, but my preferred technique is the Bellesoma Breast Lift technique. Our technique provides an exceptional breast lift, upper pole fullness, relief from neck and back pain, and no vertical breast lift scar. It uses a woman’s OWN breast tissue to produce an internal suspension technique, without the need for a breast implant. It does not disturb the nipple, areola, or breast glands, so sensation and the ability to lactate is preserved. It uses 3D scanning of your breasts and body to design a procedure specifically designed for YOU, and you alone. Finally, for patients who desire breast enlargement, it can be combined with fat grafting. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!
  
Best,
  
Jon Ver Halen, MD FACS
  
Harvard educated plastic surgeon
  
Texas “Top Doc” 2017, 2018
  
RealSelf100
  
America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 – 2018
  
BeautyAdvisor Top Contributor

Ronald V. DeMars, MD (Retired) · Answer

It sounds like you are realizing you made a less than good choice and did so without appropriate research, but really the fault may lie with not receiving adequate information ahead of time from your most important resource, your surgeon. You can get an internal bra, it's probably going to give you some significant benefit, but you really need to reduce the weight of your oversized implants at the same time if you want to have a chance of getting back the look you have as a goal.

Can’t I possibly get an internal bra placed without replacing my implants?

Answers (7)

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