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If You Can Feel the Mesh, Your Tissue Is Thin: A Surgeon on the Internal Bra

Black and white close-up photograph of a sheet of fine surgical mesh held up against hard side light so the weave shows, dark background, gloved fingertips at the edge of the frame, no face. Illustrative image. Commentary by Frank Agullo, MD, FACS.

A sheet of mesh the size of your palm. Two years, then gone, collagen left behind. I put one in nearly every breast operation I do.

Every Lift, Every Reduction, Every Augmentation

“I actually recommend internal mesh support on all patients, on breast lifts, breast reductions, and breast augmentations.”

“In a breast lift and a breast reduction, it actually helps reshape the breast tissue and support it, just like a push-up bra, to gain more upper pole fullness and avoid bottoming out and lateral displacement.”

“Of course, this is a recommendation, and some patients decline using the mesh, with the knowledge that they will not have that added support.”

Two Years

“The mesh supports the tissues for a period of up to two years. As it dissolves, it leaves behind collagen deposits, so the support remains there even well after the mesh has gone.”

“I use two main types of mesh. GalaFLEX, including GalaFLEX LITE, which is lighter, and DuraSorb mesh. The choice depends on each patient and what we want to achieve.”

The Worry

“We have not had a single case of infected mesh when we have used DuraSorb or GalaFLEX, and we have never had to remove the mesh.”

My practice. Not a study.

“We have been using internal mesh support for breast reconstruction for more than 20 years, and these techniques have been incorporated into aesthetic surgery. There are always risks associated with using any implanted material. In my experience with GalaFLEX and DuraSorb, I have seen significantly fewer complications, if any, compared to other mesh systems and dermal grafts. A lot of the symptoms alleged to have resulted from the use of mesh can actually occur when we don’t use a mesh at all.”

The Fact Nobody Tells You

“There have been cases where the mesh is palpable, and we have decreased this risk by changing to GalaFLEX LITE, which is thinner and less palpable, and to DuraSorb. The fact that the mesh can sometimes be palpated is a sign that the patient has very thin tissues, through which the mesh can be felt. If we had not used a mesh in these cases, we would probably be able to palpate the implant or visually see rippling. In these cases, the mesh is actually helping to thicken the skin and tissue envelope, and as the mesh dissolves over time, that palpability disappears.”

Feel the mesh, or feel the implant. That is the choice thin tissue gives you. Rippling is the version without the mesh.

“It is important to also realize that there are risks involved with not using a mesh. These risks include rippling, implant palpability, and implant displacement.”

She asks The answer
Do I need it? I recommend it on every lift, reduction and augmentation; declining is her call
How long is it in there? Up to two years, then collagen in its place
What if I can feel it? Thin tissue; without the mesh she would feel the implant
Does it change recovery? No, and not the drain either

Contracture

“In all actuality, there has been increasing evidence that the use of GalaFLEX and DuraSorb can decrease the risk of capsular contracture or capsular contracture recurrence. In many cases of recurrent capsular contracture, we are actually recommending a complete wrap of the implant with GalaFLEX or DuraSorb mesh to decrease the risk of recurrence.”

More on that in the capsular contracture revision read.

Recovery

“When we use a mesh, it does not change recovery time, it does not change whether we use a drain or not, and it does not affect how long the drain stays if we do decide to use one.”

The operation where the mesh earns its keep is the auto augmentation lift. The surgical read with the cost ranges is on agulloplasticsurgery.com; the patient version is on the Southwest Plastic Surgery post.

Why Choose Dr. Agullo

Double board-certified, by the American Board of Plastic Surgery and the American Board of Surgery. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly Top Doctor for 13 consecutive years.

Ready to Talk?

Ask to hold the mesh. Then decide. (915) 590-7900, text 1-866-814-0038, or book at agulloplasticsurgery.com/appointments. #StayBeautiful

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

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When the Implant Rides High and Hard: A Surgeon’s Take on Revision and Capsular Contracture

Black and white study of a woman's torso in soft light, hand resting near the collarbone. Breast implant revision commentary by Dr. Frank Agullo, MD, FACS.

A large part of my week is not first-time augmentation. It is revision.

Women come in years after surgery done somewhere else, and they describe the same handful of things. One breast riding high. A firmness that crept in. A sense that the implant has wandered off where it should be. Or simply, it has been ten years and they want a change.

These are not vanity complaints. They are mechanical problems with mechanical fixes, and they deserve a straight answer rather than a shrug.

What That High, Hard Lump Usually Is

When the description is one side that sits high and feels firm, almost like a lump, it is usually a capsular contracture.

Here is what is happening. Whenever we place an implant, the body forms a capsule of scar tissue around it. That is normal and even helpful, because it keeps the implant in place. But sometimes that capsule, driven by inflammation or an old low-grade infection, tightens and hardens around the implant. It squeezes the implant up and in, and the breast goes firm.

If it hurts, the contracture is more severe. No pain is actually a good sign. And it surprises people that this can show up long after the original surgery, sometimes many years later, but it does.

How I Actually Fix It

The repair is more than swapping the implant. I go in, remove the hardened capsule, take out the old implant, and place a new one.

When I do that and switch the patient to a Motiva implant, the risk of contracture recurring drops below one percent. The nano-surface on these implants provokes a much lower inflammatory response, which is the whole reason the recurrence rate falls so far.

To lower it further, I will often place a mesh, an internal bra layer of support, over the area. With that combination, recurrence approaches zero. And if you want to change size while we are in there, we usually can, through the same incision.

Revision Decisions at a Glance

What You Notice What It Often Means The Usual Move
One side high and firm Capsular contracture Remove capsule, exchange implant, often add mesh
Implants past ten years Older-generation wear Exchange to Motiva, reassess size and position
New, fast asymmetry over weeks Worth imaging Ultrasound or MRI, then a plan
Several prior surgeries Disturbed tissue planes Careful planning, honest expectations

“Should I Just Swap Old Implants?”

If you are at the ten-year mark with older-generation implants, an exchange is reasonable, and it is a good moment to reassess size and position at the same time. I often move patients from an older implant to a Motiva, which lasts much longer and carries far less contracture risk.

“I Have Had Several Surgeries Already. Is It Too Late?”

No. I see patients whose first operation was decades ago with several since. More history does not mean nothing can be done. It means I plan carefully and stay honest with you about what is realistic. Revision is harder than a first augmentation because the tissue planes are already disturbed, which is exactly why it should be planned, not rushed.

Why the Implant Surface Is the Whole Story

When patients ask why a Motiva exchange drops the recurrence rate so far, I bring it back to one thing: the surface. The Motiva implants I use have a nano-surface called SmoothSilk, which produces the lowest inflammatory response of any implant I know of. Capsular contracture is fundamentally an inflammatory problem. The capsule hardens because the body keeps reacting to the implant. When the implant barely provokes a reaction, the capsule that forms stays soft and thin.

That is the mechanism behind a sub-one-percent recurrence rate, and it is why I rarely reach for an older-generation implant during a revision. There is no reason to put back the kind of implant that contributed to the problem.

A Revision Is Often an Upgrade

Patients arrive bracing for damage control, and they are surprised when I tell them a revision is frequently a chance to end up better than the original. The new implants are soft, the gummy bear type, and they move with the body and settle into a natural teardrop when you stand. So while we are correcting the contracture, we can also correct a size you never loved, a position that sat too high, or an asymmetry that was there from day one. The same incision usually does all of it.

On Imaging, and Doing More at Once

If you are feeling a change, an ultrasound or MRI helps me confirm whether the implants are intact and whether what you feel is a contracture, scar, or something that needs more attention. I review your imaging before I commit to a plan.

A firm, high, or newly asymmetric implant, especially a change over a few weeks, is worth coming in for. And if you also want to refine your waistline, we can add liposuction and use J-Plasma to tighten the skin in the same setting, so it is one recovery instead of two.

Why I Take Revision Seriously

I am a double board-certified plastic surgeon with a Mayo Clinic plastic surgery fellowship, and I have been a Castle Connolly Top Doctor for thirteen consecutive years. Revision rewards a surgeon who slows down. I want to examine you and review your imaging before I promise anything, because the tissue tells me more than a photo ever will.

See the Patient-Facing Versions

For the patient-facing walkthrough, see the companion post on agulloplasticsurgery.com. For the practice overview, see the version on swplasticsurgery.com.

Ready to Talk?

If something feels high, hard, or out of place, do not sit on it. Come let me take a look.

Call the office at (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.