Internal Bra

Internal Bra

Meso BioMatrix

Meso BioMatrix® is an aesthetic-only biologic mesh that is used to provide support for breast augmentation patients. In essence, Meso® allows Dr. Durkin to create an “internal bra” for patients that maximizes implant position and projection. As an analogy, consider what happens when you put on your bra everyday. The breast mound becomes centralized, “armpit boob” disappears, and the breast projection is centered and elevated into the upper pole, producing a youthful, perky look. As well, cleavage is maximized because both breasts are brought together. With MesoBioMatrix, we are able to create this effect internally, which maximizes the benefit of your breast implant. The concept of maximizing internal support and optimizing breast implant position is the next evolution in breast aesthetics, as the results that we obtain with Meso® are clearly superior to standard breast augmentation tehniques.

What is Belladerm®?

Belladerm® is a biologic mesh that is derived from the internal lining of the abdominal wall, which is called the peritoneum. This structure is organic, thin, durable, strong, and very flexible. Mammalian peritoneum is exactly what it sounds like: donated tissue. Meso®, however, is not “dead tissue”. Instead it is a sheet of collagen and elastic fibers that has had every single epidermal cell removed, leaving behind a uniform sheet of healthy structurally sound tissue. This sheet of biologic mesh can then be sculptured to fit the specific needs and requests of the patient. The mesh is introduced through the same incision used for standard augmentation, and does not add significant recovery time to the patient. As seen below, the material is literally sewn into the patient’s breast cavity internally, creating a tailor-made capsule for your breast implant. This remarkable mesh then incorporates INTO your native breast tissue, providing an internal support network with greater strength than the natural support network of the natural female breast. The mesh is a permanent upgrade to the breast itself, as it becomes vascularized and vital by your own native tissue. In essence, the mesh integrates into the border of the pectoralis major muscle, and becomes a soft but strong extension of the muscle, which minimizes chances of implant displacement, and maximizes the positioning of your desired breast implant.

Is Meso® safe?

Absolutely. Meso is recognized by the FDA for homologous use in aesthetic breast augmentation and revision of aesthetic breast augmentations. It was introduced in 2011, and has been safely in the United States and abroad ever since. There is no relationship between Meso® and the development of breast cancer. There is no increased risk of infection with Meso®. Allergic rejection of the mesh has never been reported.

Surgeon showing biologic mesh placement in breast pocket.
Figure 1- The patient has had her implant placed internally, and the Belladerm® internal bra is being inset into the breast implant bed. In this instance, the inset is beginning on the medial side of the breast. The suture line is then extended along the inframammary fold to provide the absolute best in implant support.
Surgeon showing biomesh material placement in breast pocket intraoperatively.
Figure 2 – The mesh is now secured medially and along the lower border of the breast. Now, the mesh will be secured to the inferior portion of the pectoralis major muscle. The degree of upper pole “perkiness” and projection can now be maximized by Dr. Durkin by increasing the degree of tension on the mesh.
Surgeon pointing to breast pocket intraoperatively.
Figure 3- Once inset is complete, and implant position is perfect, the natural breast tissue is closed over the Meso® mesh. This ensures a smooth, youthful contour to the lower pole of the breast, and helps to prevent any future migration of the breast implant or the breast tissue.

Pre-op

Properative markings on patient's body showing breast assymetry.

Post-op

Patient results immediately post-opertative showing placement of bandages.

Before

After

After internal bra plastic surgery procedure showing results.

After 9 Years

Positining of breasts is maintained years after internal bra insertion.

What is MesoBioMatrix® commonly used for?

The world of breast augmentation has seen a remarkable evolution over the last 20 years. For example, the introduction and distribution of the cohesive gel silicone breast implants literally revolutionized the field of breast augmentation by improving implant reliability and durability while simultaneously maintaining the ability to enhance breast appearance. It also marked a quantum leap forward in the feel of breast implants, as silicone provides a markedly natural feel as compared to saline implants. Similar to the impact of silicone breast implants, the introduction of Meso Biomatrix® Acellular Dermal Matrix, has revolutionized the fields of breast augmentation, and as well, the field of breast implant revision. Dr. Durkin was first introduced to biologic mesh in 2011, and has incorporated its use into different facets of his aesthetic breast services.

Bottoming out breast implants-

When the implant migrates too low on the chest, and begins to lie on the upper abdomen, it usually is because the internal support system of the breast is too weak to support the implant, or because the lamella itself was damaged during implant placement. In this scenario, Belladerm® is a natural solution as it provides a strong support structure to the lower pole of the breast, allowing Dr. Durkin to elevate the implant into its natural, native position. By providing a strong foundational support to your implant, we can not only improve implant position, but maintain that position over a longer period of time because of the increased structural support offered by the mesh. These revisions are commonly undertaken through the previous breast augmentation incisions only, and no further incisions are usually required. Recovery is usually 7-10 days in length.

Moving implants from above the muscle to below the muscle –

Many women with implants placed above the muscle will develop descent of the breast mound as time goes on. We refer to this as “pseudoptosis”. In this scenario, the nipple position is well aligned with the breast implant, but the entire position of the breast is too low. The most effective solution for elevating the breast itself is to reposition the implants in a submuscular plane, and then use Belladerm® to maintain the implant below the muscle. This will markedly elevate the breast position relative to the chest and abdomen, yielding excellent upper pole fullness and cleavage, especially when combined with high and ultra-high profile implants. Many of these patients will also require a lift procedure to elevate the nipple-areolar complex to the new breast position. Recovery is usually 10-14 days in length.
Synmastia – When patients develop communication between the implant cavities, and the breast extends across the midline, we call this synmastia. This uncommon presentation requires a re-establishment of the barrier between the two breast mounds. Traditional methods have relied upon suture techniques only. With the advent of Belladerm®, we are now able to place a strong support system between the breast mounds, allowing for a much more durable and reliable repair. While this particular problem is very uncommon, repair of synmastia can be very difficult. The use of Belladerm® for synmastia has markedly improved repair durability, and the aesthetic quality of our results at Ocean Drive Plastic Surgery. We recommend use of Belladerm® in all cases of synmastia. Most repairs are done through the original breast augmentation incision, and lift procedures are usually un-necessary. Recovery is typically 7-10 days.

Implant is in the armpit-

When patients develop lateral migration of their implants, we commonly use Meso BioMatrix® to recentralize the breast implant. This is a very common request in our practice, as over time, almost all implants migrate laterally, regardless of whether they are placed above or below the muscle. With lateral support placement, many patients are able to simultaneous downsize their implant while improving their overall cleavage and upper pole fullness. This occurs because the Meso BioMatrix ® reduces the breast cavity side diameter, allowing the implant to settle in a more medial and superior position. This repair is usually done through the original breast augmentation incision, and requires 7-10 days recovery.

Capsular Contracture-

We approach capsular contracture very aggressively at our institution, as it is one of the more common problems that we treat. We have found that Meso BioMatrix ® is very effective in re-creating natural breast aesthetics in cases where contracture has altered the overall breast shape. Also, it appears that use of acellular dermal matrices (biologic meshes) may reduce the recurrence rate of contracture. We strongly recommend use of Meso BioMatrix ® in cases of contracture, as we have anecdotally seen a marked reduction in re-contracture in patients with Meso BioMatrix ®.

Breast Augmentation with Lift-

For patients who want the best possible chance for outstanding and durable results following breast lift with implants, Meso BioMatrix ® is a natural choice. Dr. Durkin’s technique at Ocean Drive Plastic Surgery was designed to maximize upper pole fullness and cleavage without altering the natural breast shape. In these cases, we pro-actively support the lateral and inferior poles of the breast with the mesh, allowing us to maximize lift and projection. Use of the mesh can be done with any lift incision (around the nipple only, lollipop, or anchor). This specific technique was developed and published by Dr. Durkin, and is one of our more commonly requested procedures.

Fitness Models and Athletes-

The use of biologic mesh has markedly improved breast augmentation outcomes in fitness competitors. At Ocean Drive Plastic Surgery, we proudly boast a very large experience with fitness competitors and breast augmentation. We have even been published nationally on this issue! Most fitness models and competitors that we see are looking to maximize cleavage and fullness, but they are absolutely unwilling to change the functionality of their chest musculature. This is one of the critical differences between athletes and non-athletes. In the athlete category, extreme care must be taken to ensure that the breast implant dimensions do not exceed to dimensions of the pectoralis major muscle. Also, every attempt to maintain fascial support to the lower and lateral poles must be made. For women who are engaging in high intensity training three times a week or more, support is the critical factor. You must maintain, or improve overall support for the athlete receiving breast augmentation. The good news is that most athletes have a robust layer of fascia, and this plane can be used to great effect during implant placement. However, many women, especially those in the fitness modeling world want to support their breast implant as much as possible, and Meso BioMatrix ® offers, in our opinion, the safest and most durable result available. Meso BioMatrix ® is very effective in this specific patient population. Our experience with this patient population is very extensive, and some of our best results have occurred when we are able to use Meso BioMatrix in primary augmentations in fitness models and competitors.
Large sized breast augmentations- For women that want the proverbial “over the top” look, there are two options: 1) Use a custom breast implant over 800cc’s in size or 2) Use non-custom breast implants with improved inferior and lateral support. Of the two options, improving inferior and lateral support offers a much more functional and anatomic solution. We routinely use Meso BioMatrix ® for women who are looking for the “wow the crowd” result.

Are there any alternatives to Meso BioMatrix?

Yes. The most common one used is called Strattice®. Dr. Durkin avidly used Strattice from 2009-2012, but then switched over to Meso BioMatrix. Strattice is porcine based skin, meaning it is derived from a deceased pig. It is FDA approved for use in humans, and it is an effective product. Cost of the two grafts is comparable, but we prefer to use Meso BioMatrix ® because it is thinner, stronger, and it has a quicker integration time than its porcine skin. The quicker the graft integrates, the faster the patient recovery. As such, we believe that Belladerm® offers the same result as Strattice, but with a safer and quicker degree of graft integration.

There are other acellular dermal matrices available, such as Alloderm, Allomax, and Seri®. These specific brands are directed more towards breast reconstruction following cancer surgery rather than aesthetic plastic surgery, and we do not offer them to our cosmetic breast patients at this time.

Why doesn’t everyone use Meso BioMatrix?

Cost. Meso BioMatrix ® is very pricey. The smallest size starts at $4000 per patient.

Internal Bra Pulication

by, Dr. Alan Durkin, MD

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