An internal mesh bra refers to a supportive scaffold placed inside the breast during certain breast surgeries. It is often used in procedures like breast augmentation, breast lift (mastopexy), or breast reconstruction. The purpose of the mesh is to provide structural support to the breast tissue, particularly in cases where the skin and tissues are weak or stretched. It acts like an internal “bra,” holding the implants or breast tissue in place and reducing the risk of complications such as implant displacement or sagging. An internal bra can also be constructed using internal stitches such as Stratafix barbed stitches.

The mesh is typically made of a biocompatible material, such as resorbable polymers, which integrate with the body’s tissues over time. One popular example is GalaFLEX, a commonly used internal scaffold.

How Does the Internal Mesh Work in the Breast?

The mesh acts as a foundation within the breast, distributing tension and providing additional support where the skin and tissues are inadequate. After insertion, the body’s natural tissue grows into the mesh, strengthening the area. This process is called tissue integration. Over time, most types of mesh dissolve, leaving behind a reinforced collagen matrix that supports the breast structure. The internal bra stitches are used to adjust the implant pocket. This is a technique to try and bring the implants closer to the midline or to correct symmastia.

Key functions include:

1. Preventing sagging: By reinforcing weak or stretched skin, the mesh reduces the chances of recurrent ptosis (drooping).

2. Stabilising implants: It helps keep implants in their correct position, particularly in patients at higher risk of implant malposition.

3. Long-lasting results: By reducing the strain on tissues, the mesh can prolong the results of a breast lift or augmentation.

What is GalaFLEX?

GalaFLEX is a bioresorbable surgical mesh commonly used in breast surgeries. It is made of poly-4-hydroxybutyrate (P4HB), a naturally derived polymer that dissolves within 18–24 months. As the mesh dissolves, it leaves behind a robust collagen structure created by the body’s healing process.

Benefits of GalaFLEX include:

• Biocompatibility: It is designed to integrate seamlessly with the body, minimising rejection risks.

• Gradual absorption: While it dissolves, the body has time to form new tissue support.

• Improved strength: The collagen framework left behind can be up to four times stronger than natural tissues.

• Customisation: GalaFLEX comes in various sizes and shapes to suit different surgical needs.

What Are the Risks of the Mesh?

While the internal mesh bra offers significant benefits, it is not without risks. These include:

1. Infection: Like any foreign material, the mesh carries a risk of infection. If infection occurs, it may need to be removed.

2. Seroma or fluid collection: Fluid can accumulate around the mesh, leading to discomfort and potentially requiring drainage.

3. Mesh exposure: If the overlying tissue is too thin, the mesh might become visible or palpable through the skin.

4. Inflammation or delayed healing: The body’s immune response can cause prolonged swelling or delayed healing.

5. Mesh migration: Rarely, the mesh may shift from its intended position.

6. Rejection or extrusion: In rare cases, the body may reject the mesh, leading to complications that require revision surgery.

7. Compromised aesthetic results: Improper placement or complications like infection can negatively affect the final appearance.

Do I Really Need a Mesh?

The decision to use a mesh depends on your individual circumstances, including:

• Weak or thin tissues: If your skin or breast tissue is significantly stretched (e.g., after weight loss or multiple surgeries), the mesh can provide essential support.

• Complex surgeries: In cases involving large implants or revisions, a mesh can improve outcomes by stabilising the results.

• High risk of recurrence: If there is a high likelihood of implant displacement or breast ptosis, a mesh can help prevent these issues.

Not all patients require a mesh, and its use is typically reserved for those with specific challenges or risks.

What Are Internal Sutures?

Internal sutures refer to stitches placed inside the body to hold tissues together during the healing process. In breast surgery, these sutures are often used to:

• Reinforce the breast pocket.

• Anchor implants in the correct position.

• Shape the breast tissue during a lift or reduction.

These sutures are typically made of durable materials like nylon or polydioxanone (PDS), which may dissolve over time or remain permanently to provide ongoing support. They are critical in ensuring a stable and long-lasting result, especially in combination with a mesh or other reinforcement methods.

How Can You Fix the Breast Pocket?

The breast pocket is the space created during breast augmentation where the implant is placed. Issues such as pocket malposition (e.g., implant moving too low or to the side) can affect the breast’s appearance and symmetry.

To fix the pocket, we may use:

1. Capsulorrhaphy (internal bra repair): This involves suturing the capsule (scar tissue) around the implant to reshape or tighten the pocket.

2. Internal sutures: Placing permanent or dissolvable stitches to reinforce the pocket and prevent further movement.

3. Mesh reinforcement: Adding an internal mesh, like GalaFLEX, to stabilise the pocket and prevent recurrence.

4. Recreating the pocket: In severe cases, the original pocket may be closed, and a new one created.

What Happens If the Mesh Becomes Infected?

If the mesh becomes infected, the situation can range from mild inflammation to a severe infection requiring surgical intervention. Signs of infection include:

• Redness, swelling, or warmth around the surgical site.

• Persistent pain or tenderness.

• Fever or flu-like symptoms.

• Fluid drainage from the incision.

Management options include:

1. Antibiotics: Mild infections can sometimes be treated with a course of antibiotics.

2. Drainage: If there is an associated seroma or abscess, it may need to be drained.

3. Mesh removal: In cases of severe infection, the mesh may need to be removed to allow the area to heal. This might delay the overall recovery process and necessitate a secondary procedure.

Infection risks can be minimised by using techniques such as a funnel, antibiotics, antibiotics solutions, following proper postoperative care, and reporting any concerns promptly.

Conclusion

The use of an internal mesh bra, such as GalaFLEX, can significantly enhance breast surgery outcomes, particularly for patients with weak tissues or complex surgical needs. However, it is not always necessary, and its use should be carefully evaluated based on individual anatomy and goals. While the risks are relatively low, understanding potential complications and how they are managed is crucial for making an informed decision. The most common method for internal bra surgery is using internal stitches which may be barbed, like Stratafix or V-Loc, or normal sutures to adjust the pocket of the breast implant.

Find out more about internal bra surgery techniques with Mr Nassab one of the best Plastic Surgeon in Manchester. We have clinics in Knutsford Cheshire and central Manchester.