Internal bra to lift implant pocket

My current implants are too small and sit too low on my chest (due to my natural anatomy). My PS recommended 650cc saline implants with an internal bra so the implants sit higher on my chest. Would the sutures be able to support such a heavy implant? How long before I can resume any upper body workouts? Any major risks with internal sutures? Is the pain worse than a regular breast augmentation?

Doctor Answers 7

Internal Bra to Lift Implant?

Without photos or additional information it is difficult to give you definitive answers. It sounds as if your surgeon is planning to do an internal capsulorraphy (suture tightening) to modify the implant pocket so that the implant sits higher on your chest wall. This will also have the effect of providing greater "cleavage". While suture modification of the implant pocket is an effective technique, the larger the implant, the more likely it is to fail over time because the sutures can fail under the weight of the implant. A 650cc implant is pretty large and saline implants put greater strain on the tissues, so unless you have large frame and strong tissues, I would be concerned that the internal bra will fail and you will be back in the same situation but with a larger implant. 

There are other techniques that can be employed to reinforce the soft tissues when creating an internal bra (such as Strattice), but they are expensive and take extra time to put in place, so the repair can get quite expensive. The surgery to elevate implant position is often done to create more upper pole fullness and cleavage. Repositioning the implant to a higher level will go a long way towards improving the upper fullness so it may not be necessary to jump up to a significantly larger implant. 

If your breasts sit too low now...are you sure that you want to go bigger

  • Bigger breasts can look great but not everyone's tissue is suitable for large implants. Yes there are techniques to raise the position of implants but they aren't guaranteed to work.  For people with low implants I would usually caution against going bigger as a solution.
  •  Dr Rodger Shortt is a plastic surgeon in Oakville.  He strives to be the best plastic surgeon and is one of the few plastic surgeons in Canada with a top 5-star rating on Realself, RateMD, and Ontario Doctor Review.  He serves patients from the GTA including Toronto, Oakville, Mississauga, Georgetown, Brampton, Burlington, Milton, and Hamilton. He is an Assistant Clinical Professor and the Director of Cosmetic Surgery Training for McMaster University.

Rodger Shortt, FRCSC
Toronto Plastic Surgeon
5.0 out of 5 stars 48 reviews

Internal bra options to support large implants

An internal bra uses a material such as Strattice, Galaflex, or SERI to support the breasts or implants. It sounds like your surgeon is planning a cpasulorrhaphy, which is sutures in the scar capsule. Your own surgeon knows the details of your situation best, but 650 is a large implant to support with a capsulorrhaphy.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 45 reviews

Dr Kayser

Thank you for your question. The natural anatomy of the breast as it relates to its position on the chest is referred to as the footprint. This is essentially determined genetically and it is very difficult to change. In patients who have had prior imlantation where a breast pocket has been developed, alterations in the position of the breast can be altered but usually only to a slight degree. This would involve either suture techniques, or creating what is called a neosubpectoral pocket where the existing capsule is used to reinforce the new one. In some situations, artificial skin, call acellular dermal matrix, can also be used to help reinforce this correction. In patients who desire a larger implant, particularly in your case where a significant volume increase is desired, this would be a direct opposing force which would necessarily work against the pocket that was elevated. Without seeing photos, it is difficult to give you any more specifics with regards to a treatment plan. I would encourage you to view the attached video for a clear description of exactly what you are describing a patient too, however, had her implants removed. I  hope this helps and have a wonderful day. Dr. Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
4.9 out of 5 stars 31 reviews

Internal bra to lift implant pocket.

The strength of supporting tissue and proper pocket placement will influence implant position for both bottoming out,and lateral displacement of implants. Internal bra could mean several things from direct capsule repair with sutures, or support of the pocket with materials such as Seri, or Strattice. You do have two issues which might work against you, larger implants and upper body workout with submuscular implants. Make sure you understand what is proposed.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.1 out of 5 stars 39 reviews

Internal bra to lift implant pocket

Thank you for the question. Based on your description, it sounds like capsule are a few techniques will be very helpful when it comes to improving breast implant positioning on your chest wall. You may wish to post photographs with your next question to allow for more specific assessment/advice.  Some general thoughts regarding the procedure you are considering may be helpful to you:

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 ( generally 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).  

 Online consultants will not be of much help to you when it comes to type/size of breast implants that can be safely used during your revision breast surgery. Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation surgery (regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. ***Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "C or D cup” or "upper pole fullness" etc means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. 

3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery ( after the use of temporary intraoperative sizers). Viewing the patient's chest wall in the upright and supine positions, with temporary sizes in place, help select the best breast implant size/profile for the specific patient.

I hope this, and the attached link (dedicated to revisionary breast augmentation surgery concerns), helps. Best wishes.


Implants and capsule

Sounds like the implants have bottomed out.  A capsule repair and possible reinforcement with an ADM may help.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.