The problem with mastopexy
…and why the internal bra mastopexy is good
The biggest problem we have with mastopexy (breast lift) is maintaining stable upper pole fullness in the breast.
This is because over time natural tissues will always tend to sag and descend, and so whilst when you first do a mastopexy you can achieve quite significant fullness in the upper part of the breasts, as everything settles that fullness becomes less prominent and turns the initial convexity into a concavity in the upper pole and a softer look, which I often describe as being more natural but patients sometimes do not like it in preference for a fuller look which is after all what most patients are after when they are having a mastopexy.
This fullness can be achieved with breast implants and sometimes patients prefer the look that is achieved with a lift combined with implants, it is not without its potential complications.
Obviously, your breast would be bigger with implants and not all patients want to be bigger.
There has been a lot of research into the possibility of techniques to achieve a more stable fullness in the upper pole and this is always something that I am keen to look into and explore, because if someone can come up with a good solution then that really would be solving a very common problem.
The problem with the internal bra mastopexy
…and why we don’t use it
There has been an internal bra around for some time in various forms and what this involves is using some form of prosthetic mesh which helps to support and hold the breast tissue up to create a more stable fullness in the upper pole.
The science behind it is sound and it seems to give good results which can be stable over the long term.
However, it has not been widely adopted and it is not something that we use regularly here in the clinic because while it can give good results, it does increase the risk of complications.
Whenever a prosthetic material is used, if there is any infection, then the prosthetic material needs to be removed.
The problem with an internal bra mastopexy is that the mesh is incorporated into the breast tissue and so it is more difficult to remove in situations of infection.
Furthermore, the mesh needs to be anchored securely because if it is not securely anchored then it will just drop with the breast tissue.
For this reason they are usually anchored into the bone of the ribs and so this can cause discomfort and again, any infection around the bony fixation can be troublesome.
By definition the mesh has to be placed relatively close to the skin because if there is too much breast tissue on top of it this tissue will sag and defeat the object, and so there is a risk that you might be able to feel the mesh or see it, and the possibility of extruding through the skin can cause problems with the healing of the skin, which is already compromised by virtue of the mastopexy surgery itself.
Personally, I feel that the balance is weighed against these meshes at the moment, but I am excited to see how things develop.
The problem we have here at the clinic is that people will read headlines or see the latest developments being advertised and think that they are the solution to their problems, but when you get down into it and really analyse the science and look at the facts and figures behind these devices being used, rather than just looking at the headline cases, you will see that there is usually no easy solution for these difficult problems.
I find the best thing is to give people a realistic expectation of what can be achieved with mastopexy and then they can make a decision on whether it is right for them or not and perform the surgery in the safest way possible giving the most predicatable outcomes that we can achieve.
At the moment we are not using the internal bra mastopexy, but we will continue to keep at the forefront of the literature and available science and aim to give you the best advice and outcomes that we can.
If you have any questions about the use of prosthetic meshes and the internal bra mastopexy please e-mail us or call us.
Or you can ask our director, Jonathan Staiano, a question LIVE on Facebook at 7 o’clock every Tuesday evening, so feel free to drop in.