Will I need an internal bra to prevent implants from bottoming out?

Question

30 yr old mom of 1, currently a 32 AA after breastfeeding for 2 years. I’m 5’4 and 105 pounds. I’ve had 2 consultations with two different board certified plastic surgeons. The first surgeon suggested I stay in the 250-350cc range and also said he’d recommend get an internal bra to help support the implant because of my lack of tissue. The second surgeon recommended no larger than 300cc but that an internal bra is not needed, nor should I worry about bottoming out. Any opinions on this?

Daniel Barrett, MD · Answer

Dear Awesome373017,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

James M. Economides, MD, FACS · Answer

For primary augmentations with a modest size implant (200-300cc range) an internal bra is generally not necessary. Of course, it is impossible to say for certain without a full examination of your tissues. If you have extremely lax tissues, an internal bra would give added support to prevent bottoming out. I would suggest weighing the pros and cons of each option: extra time/cost of internal bra vs. decreased risk of bottoming out. Gather opinions for board certified plastic surgeons with whom you are able to consult in person. Typically, each surgeon will have their own way or style of approaching a patient, but there will likely be some general consensus overall.

Brian K. Reedy, MD · Answer

Thanks for your question! Without photos, it's challenging to give you a good opinion. I don't generally use an internal bra for primary augmentations. I would suggest looking at B&A photos and reviews. That will hopefully help give you some guidance. Good luck!

Derek Fletcher, MD · Answer

Adding soft tissue support is necessary if the tissues in question do not have the necessary integrity and elasticity to support an implant over decades on their own. An in person exam is necessary to make this determination. Having a history of small breast size and breast feeding do not mean you necessarily need internal support.

Camille Cash, MD · Answer

Bioabsorbable mesh is sometimes recommended for patients having breast augmentation.  It is helpful in giving support to the tissues to prevent future issues.  The main candidates for this are those with thin tissue, those with very little breast tissue, and those considering larger implants.  Without examining you it's difficult to say if it would be recommended for you.  I've included a video on bioabsorbable mesh that I hope you find helpful.

Bryan Curtis, MD · Answer

The decision to use an internal bra (also known as an internal mesh or scaffolding) to prevent breast implants from bottoming out is typically made on a case-by-case basis and depends on several factors, including the patient's anatomy, the type of breast implant used, and the surgeon's judgment. Here are some considerations:1.) Implant Size and Weight: Larger and heavier implants may have a higher risk of bottoming out because of the additional gravitational forces they exert. In such cases, a surgeon may consider using an internal bra to provide extra support.2.) Tissue Quality: The quality of the patient's breast tissue and skin elasticity can influence the likelihood of bottoming out. If the natural breast tissue is thin or stretched, it may not provide adequate support for the implant.3.) Implant Placement: The placement of the breast implant can affect the risk of bottoming out. Subglandular (above the muscle) placement tends to have a higher risk compared to submuscular (under the muscle) placement, as the muscle provides additional support.4.) Surgical Technique: The surgical technique employed by the surgeon can also play a role in preventing bottoming out. Proper pocket creation and precise implant placement are essential.5.) Patient Goals: The patient's aesthetic goals and preferences may also factor into the decision. Some patients may opt for an internal bra to achieve a specific look or to minimize the risk of future complications.6.) Surgeon's Experience: The surgeon's experience and expertise in breast augmentation procedures are crucial. Experienced surgeons are more likely to make informed decisions regarding the use of an internal bra when necessary.If your surgeon believes that there is a significant risk of bottoming out based on your unique circumstances, they may recommend using an internal bra or another supportive technique during your breast augmentation surgery. It's essential to have a thorough consultation with your surgeon to discuss your goals, concerns, and the best approach for your individual case.Remember that each breast augmentation procedure is unique, and the decision to use an internal bra or any other technique should be based on a comprehensive evaluation by a skilled plastic surgeon with experience in breast augmentation procedures.

Connie Hiers, MD, FACS · Answer

An examination is best needed to see if an internal bra would be useful. However, at your current size, you probably have little breast tissue. I would suggest placing the implants behind the muscle. If you do heavy lifting, an internal bra could be helpful.

Olivier Deigni, MD · Answer

Hello and thank you for your questions. Without an in-person examination it is difficult to give you any specific recommendations. In general women who have loose breast skin and poor quality tissues will benefit from an internal bra. Your plastic surgeons who have examined you should be able to have a much better ideas of what your tissues may be able to handle. It seems you want to stay in the 300 cc range. Discuss these concerns with your surgeons and make sure you get all your questions answered. Best wishes!

Will I need an internal bra to prevent implants from bottoming out?

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