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.

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. 

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. 

Thanks for this question as it allows for many points to be reviewed. First, No implant placement, below or above the muscle, will have an effect plus or minus on future breast sagging. That is just result of lost breast elasticity. Second, above the muscle implants in anybody as thin as you will look edgy and unnatural. Third, an internal bra is not ever needed in first time augmentation, it is reserved for repairs of poor pockets. Fourth, Most surgeons would suggest a smooth walled round implant under the muscle for you. A 400 cc implant will be fairly large on someone of your build. Please be sure you know what the "profile" of the implant is and what "look" it is designed to make. Generally, Sientra implants are a bit excessively full looking. Best of luck with your process!

When I see a patient similar to yourself in my practice I usually recommend a partial subpectoral round smooth cohesive silicone gel breast augmentation   I do not think that this has advantages in terms of avoidance of sagging over years to come but gives you a better chance for a more natural appearing result.  The main benefit of  partial subpectoral placement is added coverage of the implant in the upper potentially visible portion of your chest and a more natural look.  The lower portion of your breast would be the same whether the implant is supra or subpectoral.  Your tissues are very thin and the likelihood of palpability and possible rippling exists but to a lesser degree with a smooth implant than a textured implant.  I prefer to place implants using a Keller funnel through either an axillary incision or periareolar incision to avoid the visibility of an inframammary scar which not infrequently is prominent in my experience.  Best wishes, Jon A Perlman M.D., FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)ABC-TV Extreme Makeover SurgeonBeverly Hills, CaliforniaIG: jonperlmanmd

 Good question since very few people understand the significance of textured implants.  With smooth breast implants, we put them in a bigger pocket than the implant and hope that the resultant capsule that forms around the implant will not shrink and form a capsule contracture and that the capsule will not stretch and result in sagging or stretching out of the skin.  Utilizing an acellular dermal matrix or internal bra is used to correct this situation when it happens but rarely, if ever, used in primary breast augmentation procedures.



With textured implants, like Sientra's textured breast implants, the pocket that is made is the same size of the implant so that your body can adhere to the texture or Velcro to you.  That way the implants weight is distributed over the entire implant and the concern you have of dropping or sagging over time is eliminated.  It also allows the implant to be placed above the muscle and therefore eliminate the problem of breast implant animation when an implant is placed below the muscle.  This is an even bigger problem when an internal bra is used.  Sientra is only available to board certified plastic surgeons and not all of them have access to this terrific device.  If you have seen someone who has offered it to you go head and get your breast augmentation.



I have added a video about the gummy bear breast implants and a web reference for you.



I hope that helps.



Best regards.