Will i need an internal bra for sientra textured 400cc over muscle? Or under muscle last longer without sagging Over years

I have been working with the internal bra procedure for more than 15 years, and with newer materials such as Galaflex available in addition to ADM's (Strattice), the indications for their use is becoming more clearly defined. However it is still a judgment call based on an assessment of the tissue envelope relative to the size of the implants. Here are a few things to know:Under muscle provides a more natural contour but does not prevent saggingTextured implants are less likely to drop but may feel less natural in a thin personADM's are not typically used with textured implants since they do not form an adherent capsuleAll things being equal, my recommendation would be get the size you want, go under the muscle using the split muscle technique (not dual plane, which can cause animation deformities), and use a textured Sientra implant. Save the expense of the internal bra for now.

Thank you for the question and picture.  In my practice, I would likely recommend the use of silicone gel breast implants placed in the sub muscular (dual plane) position.  Whether or not breast lifting will also be helpful cannot be determined based on the single photograph with your arms elevated. You may wish to post additional photographs (frontal and side views with your arms by your sides) for better assessment/advice. Although semantics can be confusing, the "internal bra" refers to a  REVISIONARY breast procedure where the breast implant capsule is "tightened up" (capsulorraphy).   In other words, the space around the breast implant is decreased in volume, thereby preventing movement of the breast implants into undesirable directions (for example bottoming out, lateral displacement, or symmastia). Sometimes, depending on the situation, additional supportive materials such as acellular dermal matrix or biosynthetic mesh may also be helpful.My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as discussed above. Working together you will come up with a good plan to achieve your goals. You may find the attached link helpful to you as you learn more.  Best wishes. 

It's a great question. The answer in my experience depends on several factors. The smallest implant that gets you where you want to go is the best. Implants less than 350cc are ideal for most patients. The bigger you go the harder you fall. Most implants are placed below the muscle. They simply do better there. An "internal bra" for a first time breast augmentation is a stretch of reality. This isn't necessary. A "working" bra that keeps your implants "up and in" will most certainly be the biggest factor in a long lasting result after implant size and position are concerned. Wearing a bra at night to keep your implants up front is important. The idea of not needing a bra after a breast augmentation is ridiculous. In my experience, the number one factor in breast implant issues is simply going too large. Second is not wearing a good bra.