Advancements in breast lift surgery

Bioabsorbable meshes such as GalaFLEX (poly4hydroxybutyrate, P4HB) and DuraSorb (polydioxanone, PDO) are used as “internal bras” during breast lift surgery to reinforce soft tissues, improve shape longevity, and enhance upper pole projection. These scaffolds are placed as a supportive sling—typically reinforcing the lower pole and inframammary fold—to offload gravitational forces from stretched skin and attenuated parenchyma while healing occurs.

Unlike permanent mesh devices used during hernia repair and bladder support, the P4HB mesh maintains strength for roughly 12–18 months as it integrates and stimulates collagen before being resorbed by the body, leaving firmer, loadbearing native tissue behind, whereas PDO mesh integrates early and resorbs over about 3–12 months while transferring load to newly formed collagenous support.

The improvement in upper pole projection is largely a biomechanical effect of robust lower pole support. By preventing downward stretching of the lower pole, “bottoming out,” and stabilizing the breast’s footprint on the chest wall, the mesh helps the lifted breast mound retain a more compact and elevated shape—with sustained upper fullness—over time. Clinical series with GalaFLEX report nearly 90% maintenance of correction after one year with few device-related complications, highlighting the longevity and safety of mesh reinforcement.

In revision and augmentation-mastopexy, meshes are noted for improved implant pocket control, reduced malposition rates, and more stable projection, functioning as an internal support similar to an underwire bra. DuraSorb, in particular, is valued for shaping the parenchyma and supporting the pocket with low complication rates, especially in challenging re-operative cases.

Ultimately, internal bras unify reconstructive and aesthetic goals. They restore deep tissue support in patients with thin tissue, larger breasts, or prior surgery, reliably extending mastopexy outcomes by reinforcing the lower pole and maintaining upper pole fullness as tissues heal and remodel.

Mathew T. Epps MD, MS, DABS is Triple Fellowship Trained Aesthetic Plastic Surgeon Specializing in Facial, Eyelid, and Breast Surgery. Visit Matheweppsmd.com or email at info@dreppsmd.com