Thank you for the good question. Semantics can be confusing; for example, the "internal bra" terminology has been used differently by different surgeons. In our practice, the "internal bra" refers to maneuvers utilized (during revisionary breast augmentation surgery) to better support the breast implants in appropriate position. These maneuvers may include adjustment of the breast capsules (capsulorraphy) and/or the use of acellular matrix or biosynthetic mesh. The "internal bra" can be especially helpful when patients are experiencing breast implant displacement problems (such as bottoming out or lateral displacement). In my practice, I prefer the use of permanent sutures, when performing these types of procedures. Suturing down to the ribs is not necessary in my opinion (and the procedure is generally very well tolerated, in most cases).
