There’s a $65 candle inspired by a unique feeling (and it’s not love). Scented with bamboo and thyme blossoms, it’s meant to capture the euphoric feeling of arriving home after a long day and throwing away your bra – move, Baies, it’s all about No bra. That elusive feeling is hard enough to evoke in a candle, but a surgery? However, this might bring to mind the ‘inner bra’, a procedure that has become more popular in recent years – perhaps along with the lyrics to Wicked’s ‘Defying Gravity’. In fact, doctors offer more details on the matter.
“Inner bra” refers to the process of having a material surgically inserted into your body to support your breasts — sometimes called “mesh” for short, although that’s not a scientific term, she explains Rady Rahban, MD, a plastic surgeon in Beverly Hills. A more accurate term might be “scaffolding”. Surgeons may find the approach useful in a variety of breast procedures, ranging from breast lifts (mastopexies) to reductions, reconstructions or augmentations, helping to maintain results longer.
“Listen, this is serious, Kathleen,” plastic surgeon Bruce Van Natta, MD, he tells me over the phone from his office in Indianapolis. “I have patients in their seventies who have had a breast lift and they don’t have to wear a bra.” William P. Adams Jr., MD, a Dallas plastic surgeon, adds that while the results aren’t permanent, adding a so-called inner bra to a breast procedure “probably doubles the time something takes.” Both doctors were part of the original US pilot program for a substance called GalaFLEX.
An absorbable bio-based polymer – the same material as some types of sutures – GalaFLEX can be shaped to look almost like a mesh half-bra. According to GalaFLEX, over a period of between 18 and 24 months, the scaffold encourages the production of new healthy tissue. This tissue can be two to four times stronger, meaning “we have much stronger support,” Van Natta says. (GalaFLEX has been cleared by the FDA for abdominal hernia repair. in the breast, its use is considered off-label, and GalaFLEX notes that it has not been cleared or approved for use in breast surgery. The FDA has not determined its safety and efficacy surgical mesh in breast surgery Not to be confused with transvaginal mesh, which the agency banned in 2019.)
Another material surgeons use is acellular dermal matrix (ADM), which is taken from living tissue, generally a cadaver or pig, and then chemically treated or “washed” of its cells. New York plastic surgeon David Hidalgo, MD, says the ADM has a “felt” feel and acts like a trellis for the flowers. “The scaffold serves as a matrix, to which the tissue adheres,” says Hidalgo. ADM has been used in soft tissue repair for decades and there have been a number of studies documenting its risks and effects. However, the FDA has not cleared or approved ADM for reconstructive breast surgery and advises that patients may have a higher chance of complications.
Unlike the choice between lace or silk, both types of “matrices” must be evaluated differently. ADM has a potential attrition factor (as a Los Angeles plastic surgeon Steven Teitelbaum, MDhe says, “It just exists [about] no one who says, “Oh well, give me pigskin”) and can be more expensive than GalaFLEX. Surgeons can also use ADM to correct capsular contracture, a potentially painful and disfiguring buildup of scar tissue that occurs in about 5 percent of implant procedures.
One of the disadvantages of both materials is that some thinner patients can sometimes feel it under the skin. But Teitelbaum finds GalaFLEX of particular benefit when doing transgender breast augmentations, as it helps lock the bottom of the implant, and has used the substance in some other types of cases. “I didn’t think you needed it,” he says, initially skeptical. “I thought my patients were so happy, why put it on? But then I saw [Van Natta’s] presentation [showing his results with and without it], and I said, “His long-term results are better than mine. I’ve got to do better.’” The GalaFLEX LITE is a new iteration that’s even more flexible and wrapable, and Van Natta believes it could one day be an “absolute perfect product” for the neck area.
Even if they are not personal fans, some surgeons see the benefit in ADM and GalaFLEX. Beverly Hills Plastic Surgeon Garth Fisher, MD, he says, “It may be ideal for some patients and surgeons, but not for me. I believe in my practice and my techniques. The material [can] add some benefit, but [also comes] with some major drawbacks that discourage me from using it.” And calling anything an “underwear” can be a stretch. Hidalgo considers the term a bit of a marketing strategy. “The concept of a structural inner bra is – well, imagination is too strong a word, because it might prove to be of some value,” she says. He uses ADM in his practice, but finds the material too weak to produce bra-like results.
All surgeons agree that an “underwire” procedure is not a lifestyle choice, something for those just hoping to ditch all their underwire. The approach could be seen as a potential bonus for a patient already considering certain types of breast surgery. Van Natta says, “If someone didn’t need a lift, then they wouldn’t need the GalaFLEX.” Melinda Farina, founder of plastic surgery consulting firm Beauty Brokers Inc., says, “I have a lot of young girls who come in and say, ‘I want the inner bra.’ I don’t want to wear a bra again.’ And I’m like, “No, no, that’s not what it’s really about.”
A version of this story appears in the April 2024 issue of ELLE.
