I've had some bottoming out since my reduction in 2007. I'd like to have an internal bra with my next reduction

Hi Dr. Fox! For patients undergoing a breast lift or breast reduction, I do utilize an absorbable mesh to create an internal support bra to maintain the shape and minimize changes to the breast over time. As far as details of the exact procedure I would recommend based on your photo, it will really depend on what your ultimate size goal is. If you generally like the size of your breasts (ie, do you like they look in clothing in a supportive bra), then you may only need a redo-breast lift (mastopexy). For patients that are happy with the volume of their breasts, I do a tissue sparing technique, which essentially an auto-augmentation, conserving all of your breast tissue, but lifting the overall breast and bringing the nipple-areola to a higher, more aesthetic position. If you would like to be smaller from a volume standpoint, then I can remove breast tissue for a reduction as well, as well as also using absorbable mesh to maintain the shape over time. Best of luck in your aesthetic journey!

An internal bra, which uses a supportive mesh or your own tissue, can help prevent this and provide additional support. It’s a good option to discuss with your surgeon for your next procedure to ensure you get the results you want. In addition, some techniques are more prone to bottoming out than others. A vertical pattern based on a superior pedicle also may be less likely to have bottoming out. Part of the discussion with your surgeon should include the techniques available and the reason why one approach may be better than another for you.

An internal bra can be added for better support, but I also recommend going some smaller to decrease the weight on your previously stretched skin.