Medically reviewed content from Don R. Revis, Jr., MD, FACS, double board-certified plastic surgeon

Most breast implant complications get treated the same way, regardless of cause: take the old implant out, put a new one in, hope gravity behaves differently this time. The Original Internal Bra technique exists because that approach doesn’t actually fix the underlying problem for a specific, common category of complications — and understanding why explains a lot about how it works.

The Problem the Internal Bra Was Designed to Solve

Bottoming out, double bubble, and synmastia all share a root cause: the implant pocket itself has stretched, dropped, or shifted out of position. Simply swapping the implant inside that same compromised pocket doesn’t correct the structural problem — the new implant, whatever its size, will tend to settle right back into the same stretched space. The Internal Bra technique was developed specifically to address the pocket, not just the implant.

How the Internal Bra Technique Works, Step by Step

The procedure uses lighted retractors to directly visualize and work within the implant pocket. From there, it involves two coordinated steps:

• Expanding the pocket where it’s needed: a capsulotomy opens space superiorly and medially, allowing the implant to be repositioned higher and more centrally for better upper pole fullness and cleavage.
• Closing off the pocket where it’s failed: the stretched lower and lateral portion of the pocket is closed using permanent sutures, placed so they never directly contact the implant itself — creating an internal support structure that holds the new position in place.

Why Permanent Sutures Instead of Dissolvable Ones

Dissolvable sutures break down over time — which is exactly the problem with using them to hold a stretched pocket in a new position. Once they dissolve, there’s nothing left to prevent the same gradual stretching that caused the original problem. Permanent sutures are used specifically because the correction is meant to hold for years, not months.

What Makes This Different From a Standard Implant Exchange

A standard implant exchange addresses the implant. The Internal Bra technique addresses the pocket the implant sits in. That distinction is why implant size can typically be changed — up, down, or kept the same — without compromising the repair: the durability of the correction comes from the rebuilt pocket structure, not from the specific implant chosen to go inside it. In select cases, an acellular dermal matrix product like Strattice is also used to reinforce the repair further.

Documented Results

Case examples from this practice include a patient in her early thirties, treated for bottoming out and a wide implant gap, corrected with the Internal Bra technique alongside an implant exchange to a moderate-plus profile implant. Another case, an international patient in her mid-twenties presenting with bottoming out and rippling, was treated with the Internal Bra technique combined with Strattice placement and an implant exchange. Full healing for the internal support structure generally takes around 12 weeks, after which results are designed to last for many years — a long-term outcome has been documented as far out as a decade post-repair.

Who Is a Candidate for the Internal Bra Technique?

The technique is specifically suited to patients dealing with bottoming out, double bubble deformity, or synmastia — problems rooted in implant position relative to the chest wall, rather than issues like capsular contracture, which involves the scar capsule rather than pocket position. An in-person or photo-based evaluation is the way to confirm whether this is the right approach for your specific situation.

Frequently Asked Questions

Is the Internal Bra technique the same as a standard revision?

It’s a specific approach within revision surgery, purpose-built for pocket-related problems like bottoming out, double bubble, and synmastia — not a universal revision technique for every complication.

Can I increase my implant size during an Internal Bra procedure?

Yes — roughly 60% of patients undergoing this procedure increase their implant size, based on this practice’s own case data, with the remainder keeping the same size or sizing down.

How long does recovery take?

Initial recovery follows a similar timeline to standard augmentation surgery, with full healing of the internal support structure taking around 12 weeks.

Is this technique patented or exclusive to one practice?

The Original Internal Bra is a trademarked technique developed by Dr. Revis; the general principle of internal pocket support is used in various forms across plastic surgery, but this specific method and name are unique to this practice.

If bottoming out, double bubble, or synmastia is behind your current concerns, schedule a consultation to find out whether the Internal Bra technique is the right fit.