Internal Bra Technique for Breast Augmentation

Speaker 1 (00:06): This is Behind the Double Doors with Dr. Bob Basu.

Dr. Bob Basu (00:12): We've been getting a lot of questions from patients about my Internal Bra Technique and it's something I've been doing for over a decade plus now. And so today I'd like to dedicate our podcast to talking about what the Internal Bra Technique is. So first, who's a candidate for the Internal Bra Technique? Well, if you're someone that's listening that has had implant augmentation before, and you feel your breasts are not sitting high enough, or perhaps your breasts are falling to the side, or you're getting a saggier result than you really want, then you may be a candidate for the Internal Bra Technique. Or if you're a listener, who's had an augmentation with a lift before, and you're just not happy with where your breasts sit, you're getting a recurrence of sagging.

Dr. Bob Basu (00:57): I mean, in other words, the breasts are falling lower to the position where you want them to be. Or they're falling to the side, or you want to recreate the result that you get when you wear a very supportive pushup bra, and you want to get that result without having to wear a bra, then you may be a candidate for this Internal Bra Technique. The next question is really what is the Internal Bra Technique? For me to explain that, it's super important for me to talk about tissue support. When I meet with patients during consultations, I ask them a question, and this question is really under discussed in plastic surgery. In fact, it's one of the reasons why I wrote that cosmetic surgery textbook and you can get details on that in our show notes. The question is, whenever we do an augmentation with an implant, or we do an augmentation with a lift, what is it that actually holds the breast up when we do these procedures?

Dr. Bob Basu (01:53): The answer is, ultimately, it's your tissue quality. So what do we do when a patient's tissue has been weakened, weakened by having kids, weight fluctuations or weight loss, or they're just born with weak tissue? I see a lot of young women who have not had kids who are just born with weak tissue. So what do we do for these patients when their tissue's too weak to support their breasts and support their implant? And that's where the Internal Bra Technique comes into play. The Internal Bra Technique uses something else besides the patient's own tissue to provide much needed support. Now that something else is a material called GalaFLEX.

Dr. Bob Basu (02:32): I like to use GalaFLEX for my cosmetic patients, but there are other materials that can be utilized for the Internal Bra Technique, but we can talk about them a little bit. The GalaFLEX essentially provides a much needed support to the breast and the breast implant, to hold it to where the patient wants to be. This allows us to maintain nice, full proportionate cleavage. It allows us to achieve more upper pole volume. In other words, volume in the upper portion of the breast. It allows patients to achieve that push up bra look without having to wear a bra.

Dr. Bob Basu (03:03): And for many patients, it prevents the implants from falling to the side. And it's a great long lasting way to get long term support using GalaFLEX. There are a lot of different materials that are out there now in the market that surgeons can utilize for the Internal Bra Technique. In my early years of practice, I would utilize materials called AlloDerm or Strattice. AlloDerm is made out of a human cadaver source. It's basically dermis or skin that can be placed for support. I've also utilized porcine skin called Strattice. They're all very good products, but these products are very, very expensive. Fast forward to the last couple years, I've switched over to utilizing GalaFLEX. And I love GalaFLEX because it's not coming from an animal or human source. GalaFLEX is bioresorbable, meaning it actually slowly dissolves away. It's made out of a material called P4HB.

Dr. Bob Basu (03:59): Translation, it's made out of a suture material that's been around for decades. But the suture material has been actually weaved into a matrix. Now, when I say GalaFLEX surgical mesh, I always get this worried look on patient's faces. Because they're like "surgical mesh, I saw those TV commercials. That's the bad stuff from hernias and OB GYN surgery, right? Bladder slings." Well, that's not what this is. Although GalaFLEX is called a surgical mesh, it's not that foreign body mesh that could potentially cause problems. This is actually a bioresorbable mesh. In other words, it's a suture material that slowly dissolves over time, over 18 to 24 months. I call it a regenerative tissue matrix. In other words, as the suture slowly dissolves, your own natural collagen actually replaces that suture. And the studies have shown that what is left behind once that GalaFLEX dissolves, that tissue material that grows in is actually three to five times stronger than your own native tissue.

Dr. Bob Basu (05:02): And we're really talking about long term support. I've been using Internal Bra Techniques for almost 15 years now and I can tell you that I don't have a single recurrence. Another common question is can you feel the mesh? Rarely. Can it be palpable? Yes, in patients that have super, super thin tissue, it's absolutely possible that you can palpate it, but it does dissolve over time. And that's another reason why I love GalaFLEX, because it is really forgiving. I find that my patients heal and see their results faster. And since this is cosmetic surgery, it's not covered by insurance, the cost of GalaFLEX is a fraction of what some of the other materials cost. I'm a really big fan of it, especially since it gives long term results. Is the Internal Bras Technique something that I can do in a primary breast augmentation, or do I reserve it for revision breast surgery?

Dr. Bob Basu (05:55): It depends on the patient. Most patients who are having a primary breast augmentation, that means a breast augmentation for the first time, generally don't need the Internal Bra Technique. But have I performed the Internal Bra Technique for patients who are having implants for the first time? Absolutely. For instance, patients who work out a lot or have a history of weight fluctuations, or they're younger patients that just have weak tissue in general and they want more support. I think it's absolutely a great idea to use the Internal Bra Technique in a first time breast augmentation, but it may not be necessary. Again, this is part of the discussion that I have with my patients. For revisional breast surgery, it's a very, very powerful tool in so many different scenarios.

Dr. Bob Basu (06:38): In many cases, particularly patients who've lost weight or moms that have had significant post pregnancy changes to their breast tissue, I simply can't achieve the results that I get with my Internal Bra Technique using the patient's own tissue by itself. It's a very, very powerful tool. And I love achieving those gorgeous results for patients, especially when they have weak tissue. Now, another common question that I get from patients is is the recovery longer and more painful with the Internal Bra Technique? And the good news is the answer is no. In my experience, my patients have pretty much the same recovery as an augmentation or an augmentation and lift. And typically most patients will have a little bit of soreness for maybe a few days after surgery, but they're feeling pretty good three to five days after surgery. And it's the same recovery, no heavy lifting or strenuous activity for about three to four weeks. After four to five weeks, I clear patients to go back to the gym.

Dr. Bob Basu (07:34): Another common question I get is can the Internal Bra Technique be done if you don't have an implant? And that's a fantastic question. I do have colleagues around the country that have utilized an internal bra with breast lifts without implants. In my opinion, I'm going to be very honest with my listeners, I'm quite frankly not that impressed with the results. In my experience, the wow factor results occur when I use the Internal Bra Technique with implants in a primary breast augmentation or revision breast augmentation, or a breast augmentation with a lift or a revisional breast augmentation with a lift. I find that there are other techniques when you're doing a breast lift without implants that can help sustain this support of the breast where you really don't need the Internal Bra Technique. For those patients that don't want a breast implant or don't need a breast implant, we do have a very powerful breast lift auto augmentation of cleavage techniques, which we discuss in a different podcast.

Dr. Bob Basu (08:38): Check the show notes for the reference. But generally I reserve the Internal Bra Technique with GalaFLEX for cases that involve a breast implant. Here's another question from one of our podcast listeners. Can you do an internal bra with every variation of implant placement or does it only work with certain ones, above, below, or dual plane technique? Fantastic question. You can actually do an Internal Bra Technique with any variation. In my experience, I find that using the Internal Bra Technique when I'm doing either a dual plane or under the muscle technique, helps me sleep better at night. And here's the reason why. What's holding onto that internal bra? When we do the Internal Bra Technique, and again, I'm going to give you another reference to the show notes to a diagram that illustrates what we're actually doing.

Dr. Bob Basu (09:27): It's actually from the chapter I wrote in my cosmetic breast surgery textbook. So in the textbook, there's a diagram that illustrates how we actually place the GalaFLEX in the breast. And once you see this image, it'll become crystal clear how it all works. And when you look at the diagram, you'll see that there's a side view of a breast, there's an implant, there's a muscle that covers the implant and it shows where the GalaFLEX sit. And think of it this way, if you can't look at the diagram right now, because you're driving or listening to the podcast, think about where the cups are located in a very supportive pushup bra. It's in the underside and laterally of your breasts, right? So that's exactly where the GalaFLEX is sitting. What we do with the Internal Bra Technique is that the bottom edge of that material is placed or anchored to your chest wall.

Dr. Bob Basu (10:19): Chest wall's a strong place, so it's good anchoring. But the upper border of that Internal Bra Technique is anchored to the muscle. I like to anchor it to the muscle because it gives good upper pole fixation or strength, so that internal bra material doesn't move. And I like that strength in the upper and lower fixation, because I know that when I finish that case, that material ain't going anywhere and that gives me certainty of outcome. You can inset the upper border of the GalaFLEX internal bra material to other parts of the anatomy in the breast. But I like the confidence that I get when I fixate it to the muscle. So my preferred approach is to do a dual plane placement of the implant or an under the muscle technique implant. But again, you can do the Internal Bra Technique in other implant pockets. Here's another question from one of our listeners.

Dr. Bob Basu (11:10): How many times have you done the Internal Bra Technique? Wow, probably hundreds. I probably do it on a weekly basis. That's something that I've developed a national reputation for. And prior to COVID we were even having patients fly from overseas, coming in for the Internal Bra Technique. Look, these are complex cases. A lot of surgeons don't take on these cases because these are complex reconstructive procedures. This is cosmetic surgery, but oftentimes for patients that have had prior surgical attempts, I'm the fourth surgeon trying to make things better. And so I always tell patients, particularly in the more complex cases, that this is very complicated surgery. Even with my volume of experience with Internal Bra Techniques, there's some cases that can take me three and a half to four and a half hours just to get it right. And I tell patients that this is much more than just doing an augmentation with a lift.

Dr. Bob Basu (12:05): We're actually re-engineering your breasts and overcoming the challenges with weak tissue, oftentimes we're actually raising the footprint of your breast on your chest wall. Remember, some women, their breasts are just sitting very low on their chest wall and they've got a really tall chest wall height. With the Internal Bra Technique, I can actually raise the footprint of the breasts from the chest wall. And so we're doing some special things that are much, much more complicated than just an augmentation and a lift. We're providing more support. We're looking at symmetry. We have to look at nipple position. We have to look at lateral position. There's a lot of variables that we're juggling to make it just right. So this is a much more complex surgery. I started my plastic surgery career doing post mastectomy breast reconstruction. And I think because I gained a lot of experience early on, building something quite frankly from nothing, I think it's really made me a much more adept and skilled aesthetic breast surgeon.

Dr. Bob Basu (13:06): It builds a certain skill set that in complex, really complex aesthetic cases, I'm prepared to basically almost handle anything that I see. And that comes with experience. And that's where that 17 years of experience comes. That's where the white hair and thinning hair comes into play. It's experience. You can definitely see before after photos on our website galleries, you can visit basuplasticsurgery.com. You can also follow us on Instagram @BasuPlasticSurgery. We periodically post some before after transformations with the Internal Bra Technique.

Dr. Bob Basu (13:40): Also, on a prior podcast, we interviewed 90 Day Fiance star @BossBrittany, about her experience with the revisional breast surgery, with the Internal Bra Technique. And she was a fascinating guest who actually honestly shared her experience and journey. To learn more about the Internal Bra Technique, to find out if you're a candidate, to learn about prices, financing, the first thing to do is to call our office at (713) 799-2278 and ask to speak to one of our friendly patient consultants. They're very knowledgeable about what I do in my repertoire with the Internal Bra Technique and revisional breast surgery. And they'll walk you through the process so you're fully prepared and set you up to visit with me for consultation. If you are from out of town, it is quite frequent we do virtual consultations as well.

Speaker 1 (14:30): Basu Aesthetics and Plastic Surgery is located in northwest Houston in the Towne Lake area of Cypress. If you'd like to be a guest or ask a question for Dr. Basu to answer on the podcast, go to Basuplasticsurgery.com/podcast. On Instagram, follow Dr. Basu and the team @BasuPlasticSurgery. That's B-A-S-U plastic surgery. Behind the Double Doors is a production of TheAxis, theaxis.io