Can I have an "Internal Bra" procedure done with large implants? (Photo)

You do have some asymmetry with your right breast a bit lower than your left.  This may be due to just normal asymmetry that you had preop or you, indeed, bottomed out.  Hard to say from your photos, but I suspect the former.  Regardless, the decision for revision should be based on whether this asymmetry bothers you.  Clearly smaller lighter implants may stretch you out less.  However, this may not be desirable as you may prefer the larger volume.  Internal bra procedures will not work in your case.  You will require internal soft tissue support.  This can be achieved with the use of ADM, or  mesh which I prefer.Good luck, Ary Krau MD FACS

Having a capsulorrhaphy, without tissue reinforcement, and keeping large implants in place will have a high likelihood of failure over time.  The most likely underlying issue is that your implants are heavier than your tissue can handle and have therefore stretched your soft tissues.  The most reliable option would be to downsize (to reduce the weight), to tighten the pockets, and to reinforce with a material such as an acellular dermal matrix (ADM).  Another, potentially less expensive option (assuming you are under the muscle) would be to forgo the ADM, perform a neosubpectoral pocket dissection to close out the old pocket and create a new, more precise space, and to place smaller textured implants that will be less likely to settle excessively.  If you choose to reuse your current implants, I would definitely recommend reinforcing a capsulorrhaphy with an ADM to take tension of the suture repair line and provide additional internal support.  Best of luck!

During breast implant surgery a pocket is created carefully to maintain certain folds on the sides and bottom of the breast. At times, the space for the breast implant becomes too large on the side of the chest or the tissue stretches and the implants fall too much to the side. This is most easily seen when the patient is lying on her back. On rare occasion, the implants can move towards the patient’s #armpit.
Treatment to address this generally requires closing the space.  That procedure is called a #capsulorrhaphy. In this case, the capsule is closed off internally much as we do when we are trying to raise the breast fold. The capsule is then closed with sutures and Acellular Dermis Matrix (#ADM) or other soft tissue substitutes may be used to further support this correction. Perhaps, the ADM may be what you are referring to when inquiring about #internal #bra.
Nevertheless, the technique really depends on the goal or #results you are trying to achieve. This should be discussed in more detail with your plastic surgeon to better plan your revision strategy. Such will determine not only the outcomes, but if a #mesh or #internal #bra should be incorporated. 
 Any #revision has risks of unhappy outcome or other complications. Also, the right implant for the revision is contingent on shape of body and your desired outcome. Typically, it's best to wait 6 to 12 months depending on the reason for #revision.  Matters such as sagging, drooping  and size change will not improve with time. As with all cosmetic surgery, results will be rewarding if expectations are realistic.

A capsulorrhaphy alone may not give your implants enough support to prevent further sagging.  A dermal graft such as Strattice may be necessary to help provide a "hammock type sling" or "internal bra" for additional support.  Going down in size also helps to lessen your risks of recurrent sagging.
I hope this was helpful.

Thank you for your picture and questions. I think what you need depends on your goals. If you want to remain the same size, then you could keep your current implants and do a repair of the pocket, either with sutures or mesh. The mesh just adds strength to the repair and prevents recurrence. If you want to go to a smaller size, then you can downsize the implant and revise both pockets. The second doctor is likely concerned about the recurrence with just a suture repair and this is understandable with larger implants. There are no guarantees, even with a mesh repair, that this problem will not come back. But what is right for you all depends on what your goals and objectives are and how much risk you are willing to take. Hope this helps! Best of luck!

Good morning!Absolutely you are an excellent candidate for the Internal Bra, my strong permanent internal suturing technique which corrects bottoming out and supports your implants over the long term. It is even MORE important with large implants, because it helps support the weight.The Internal Bra is the most common revision procedure I perform, 5-6 times a week- it works and it lasts. I have attached a link to my Internal Bra / Breast Augmentation Revision photo gallery for your review- hope it helps!

Thank you for the question and photo.  I think a pocket repair can be performed while still using your current implants.  Of course, in the end what can or cannot be done is alsa influenced by the plastic surgeon that you end of choosing as he/she will have their own ways of doing things.Good luck with your breast shaping journey.

Thank you for the good question. 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).   In your case, I do not think that downsizing of breast implants is necessary or mandatory when it comes to successful revisionary breast surgery utilizing he techniques.  Of course, much will be surgeon experience dependent,  understanding of course that this type of surgery is not 100% successful (regardless of what size breast implant utilized or who does the surgery).  Careful attention to postoperative activity restriction is also important. I hope this, and the attached link/video, helps. Best wishes.

Yes, I can do an internal bra with any breast procedure but most commonly in conjunction with an uplift and many times with XL sizes. What it is is a formed mesh that I place which forms scar within the area placed and so helps hold and support the breast tissue for unfortunately the breast does sag with more weight of implant. 

I would suggest a strong suture repair be tried before any use of Strattice or other ADM materials. You can keep the size you have but understand that the heavier the implant, the higher the chance of failure. I insist on a specific underwire bra 24/7 for 4 months and no pec muscle work or bouncing exercise like running for that time.