An “internal bra” , as the name suggests, is the use of external material to support the weight of a surgically lifted breast.
A short history of breast lift
Mastopexy is the medical term for “breast lift” and this has traditionally been done by removing excess skin from the bottom portion of the breast and rearranging and suturing the internal breast tissue to provide the necessary support to create a tighter, perkier breast. The addition of an implant is often recommended in breast lift to help replace lost volume and to achieve more fullness at the top portion of the breast. This, however, does add some weight to the newly lifted breast and may put more stress on the tightened, lower portion of the breast.
But what happens if the tightened skin cannot hold the just-lifted breast?
One of the risks of traditional breast lifting is excess fullness to the lower breast and downward displacement of the implant. This is often referred to as “bottoming out”. Whether this happens or not depends on multiple factors. For example, if the patient has very thin skin, this usually means the deeper “dermal” layer is thin also. This is an important layer when suturing the incision back together. A larger , more durable suture can be placed in a thicker layer. Another example is the use of a larger volume implant which means more weight and again, more tension on the incision over time.
As the saying goes, “Necessity is the mother of invention.”
Plastic surgeons started investigating other means of supporting the breast internally rather than relying on the skin. The “internal bra” technique involves creating a strong envelope inside the breast by securing these materials to more structurally sound tissues like muscle and even the chest wall. Historically, several materials have been tried. Some were short lived. Non-absorbable synthetic meshes sound good in theory, but a high chance of infection makes them high risk. Absorbable meshes have also been used but their use has dwindled also because of the incidence of infection and possible loss of support when the mesh dissolves. The most recent concept is the use of acellular dermal matrix products or ADM’s.
ADM’s (acellular dermal matrix products) help solve the problem of supporting the breast without the side effects of previous internal bra technologies.
These are basically graft materials of porcine or human origin that have gone through a complex process of cell elimination so as to not trigger an immune response. Recall that, as humans, we are genetically programmed to not accept tissues transplanted from other humans or other species. Hence the concept of “rejection”, otherwise called the graft vs. host response. We can significantly diminish this response by matching the genetic host’s DNA sequence as close as possible, such as in kidney transplant. Of course, immunosuppressive medications are necessary to thwart the rejection response making the graft “tolerable.” ADM’s have changed the playing field in plastic surgery. These products are stripped of all the cells which leaves just the framework or matrix. It turns out that the signal that triggers the immune response is on the cell!!! So no cells, no immune response. This matrix then gets populated with the patients native cells and becomes a permanent part of them. Under a microscope it looks light loosely woven fabric into which living cells migrate. These ADM’s come in different sizes and thicknesses and provide excellent structural support. They are highly resistant to infection , and in fact, are often used in cases of infection such as replacement of an infected mesh.
What does an ADM look like?
Here’s a link to a google image search for the term acellular dermal matrix [warning: there are some graphic images that show in the results, since this type of product is used in many types of reconstructive surgery]. Here is a photo of a shaped porcine product that is often used.
In summary, the term “internal bra” is usually synonymous with the use of grafted tissue that has reliable structural properties and is void of any cells. It is frequently indicated for additional support in breast lifts with implants.