A Top Plastic Surgeon Shares the Latest Advancements in the World of Breast Enhancement

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One of the top names in the country when it comes to aesthetic breast enhancement, Louisville, KY plastic surgeon Bradley Calobrace, MD shares the latest advancements in the field, and everything you should know if you’re considering surgery.  

What are your specialties?

“What I’m most known for around the world is definitely revisional breast surgery, and breast lifting for all different types of reasons, so much so that I wrote a textbook on the subject that came out this year. I also did a five-part video series on breast lifting for QMP (Quality Medical Publishing). I’m also currently writing a textbook on revisional breast surgery for QMP publishing.”

What’s the latest in breast surgery right now?

“One of the most important things that’s happened in the United States, especially over the past two years, has be the discontinued use of textured implants due to their rare but possible association with Breast Implant Associated Lymphoma (BIA-ALCL). I’ve worked a lot with that because I’m the chair of the BIA-ALCL committee for our aesthetic society. Smooth implants have no association with lymphoma, and thus are safe to use. The reason we were using textured implants was because they created stability in the breasts and lowered the rate for capsular contracture. With smooth implants, we have to deal with these issues in different ways.”

Is this where an “internal bra” comes into play?

“Yes. Fortunately, over the last five or six years, I’ve started using a lot more ‘internal bras’ which are composed of a mesh—or better known as a scaffolding—that is placed as a hammock to reinforce the breast implant and hold it in position, especially when using smooth implants. The mesh is placed inside the breast to provide support—it creates sort of a stabilizing platform for the body’s own internal bra that makes the breasts look perky—and slowly but surely it disappears and dissolves away in one to two years, but the strength maintains. Everybody wants an uplifted breast that looks like they’re in a bra without having a bra on. The meshes have become a powerful tool for making breast surgery better for patients, and we’re continuing to do a lot of research on this! They’re also using some of these meshes in breast reconstruction for cancer patients and abdominal hernia repair.”

What is the mesh made of?

“There are two different ones: One is made of something called P4HB (poly-4-hydroxybutyrate), and it’s from a company called Galatea. It’s a synthetic mesh that’s manufactured to give strength, act as a scaffolding and then gets absorbed over time. The other one is called DuraSorb. It’s newer, from a company called SIA, and it’s made of PDO (polydioxanone), which is similar to the sutures we use all the time. However, it’s made like a screen door rather a barbed suture. The P4HB lasts about 18 to 24 months before it dissolves, and the DuraSorb is gone at one year. I’ve never seen any significant complication from using these products.”

Does it work on any size breast?

“Yes, it can work on any size breast because we’re doing another procedure with it, such as a breast lift or breast augmentation. When somebody has some complication with their breast implants—capsular contracture or malpositioning—we use it to reinforce the smooth implants. Patients who generally need an internal are those who are getting larger implants because they need more stability, and those who don’t have great soft tissue quality. I also use these often in weight-loss patients or women who have had multiple pregnancies with lots of changes to their breasts and their breasts are very thin and stretched. That type of skin can’t hold up an implant if it can’t hold up itself. Additionally, when patients have very sloping chest walls, implants can slide down into the armpit or bottom out. The mesh can effectively prevent this, producing a more beautiful breast.”

How is this different than a thread lift in the breast?

“That’s quite different. A thread lift uses barbed sutures to the lift breast with the goal of avoiding breast lift surgery. It’s not supporting the breast. Those sutures aren’t that supportive and often fail to lift adequately. Thread lifts pull up from the top like a rope, as opposed to the internal bras, which support from the bottom and are way more powerful.”

What about fat grafting. Can that be used to make the breasts look lifted too?

“One of the other most powerful methods is the use of fat grafting. It’s becoming a mainstay in aesthetic breast surgery. Even if I’m putting in implants, the addition of fat grafting is one of those things that just makes the result perfect. It lets you fix all those little contour problems and asymmetries. One place it’s extremely important today is cases where patients don’t want their breast implants anymore. I will take the implants out, do a breast lift auto-augmentation with their own breast tissue and then add fat grafting. This has been extremely common in my practice. Breast implants are still fantastic, but when we don’t need them, it’s great to have an alternative that uses the patient’s own tissue. This isn’t for someone who is an A-cup and wants to be a C-cup, but it works for many other patients.”

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