Tell me what to expect from permanent sutures/Internal bra?

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).
  I hope this helps. Best wishes.

An internal bra is not a capsulorrhaphy (sutures in the scar capsule.) It is placement of a material that provides support for either an implant, the breast tissue, or both. Materials most used for this are Strattice (for implant coverage and support) and Galaflex mesh (for breast lift, with or without implants.) Both provide long term support. There is some discomfort from the sutures, but I do not sew directly to the ribs as that is unnecessarily painful. 

Usually when people refer to the "internal bra" technique in breast revision they are referring to one of two things: 1. suturing a capsule together, what surgeons call capsulhorraphy or 2. placing some kind of synthetic or allograft support around an implant.  Unfortunately neither technique works well as the capsule usually stretches, and all "breast support" implants have been frought with complications.  THe only true internal bre type technique that works is called subfascial placement.  True subfascial placement uses the body's own living tissue called fascia to support and shape the implant like a bra inside the breast.  The fascia can be used for both primary and revisional work to lend support.  I hope this helps!All the best,Rian A. Maercks M.D.