Breast · Abu Dhabi & Dubai
Internal Bra Technique
Medically reviewed by Dr. Paulo Michels, Board-Certified Plastic Surgeon· Updated 10 September 2026
The internal bra is a surgical technique — not a product — that builds a support structure inside the breast during a lift, augmentation, reduction, revision or explant, so the reshaped tissue or implant is held in position and sagging returns far more slowly. It can be built from the patient's own tissue or from scaffold materials such as GalaFLEX, TIGR Matrix or ADM. Dr. Paulo Michels performs an autologous Internal Bra in Abu Dhabi — a sling of the patient's own fascia and muscle plus reinforcing sutures at the breast fold — for patients from Dubai and across the UAE at Elyzee Hospital.
The internal bra has become one of the most-searched terms in breast surgery — and one of the least understood. Patients arrive at consultation asking for it by name, having read that it makes a breast lift last longer, that it involves a mesh, or that it is a new operation of its own. The first thing to clarify is that the internal bra is a technique, not a product: GalaFLEX, TIGR Matrix and ADM are materials some surgeons use to build it, and the patient’s own tissue is another. Dr. Paulo Michels has used an internal bra in his breast surgery for years; this page explains what the technique is, what it can be built from, why his standard version is autologous, who genuinely benefits, and what it can and cannot promise.
What is an internal bra, in plain language?
Every breast lift faces the same problem. The surgeon removes stretched skin, reshapes the tissue and raises the nipple — and then the whole reshaped breast is held in place by the tightened skin. Skin is not a structural material. It stretches again with gravity, time, weight change and pregnancy, and a lift held by skin alone gradually settles.
An internal bra transfers that load away from the skin to a deeper, stronger layer. Like the band and underwire of a good bra, it supports the breast from below and holds the fold in position — but it is built inside the breast, during the operation, and it stays there. The term is a patient-friendly metaphor, not a single defined procedure: it covers several techniques with the same aim.
How does Dr. Michels build the internal bra?
Dr. Michels’ Internal Bra is autologous — built from the patient’s own tissue rather than a manufactured scaffold. Two elements are combined, depending on the operation:
The fascial-muscular sling. During a breast lift, flaps of the fascia and muscle of the chest wall are raised and secured beneath the reshaped breast, creating a robust hammock that supports the tissue natively. The lifted breast rests on living tissue with its own blood supply, not on skin.
Fold reinforcement. Permanent internal sutures rebuild and reinforce the inframammary fold — the shelf at the base of the breast. In breast augmentation, this is the element that prevents an implant from sliding below the fold (bottoming out) over the years; in a lift, it defines the fold and stops the lower breast from stretching downwards.
No incisions are added: the sling and sutures are created through the same access used for the lift or augmentation, and the skin is closed with cyanoacrylate surgical glue.
What can an internal bra be built from?
Much of what patients read online treats “internal bra” and “mesh” as the same thing. They are not. The technique is the supporting layer; the material is a separate choice, and four are in use worldwide:
Your own tissue (autologous). Flaps of fascia and muscle raised and secured as a sling, plus permanent sutures at the fold. Living, vascularised, permanent, nothing to resorb and no device cost. This is Dr. Michels’ standard.
GalaFLEX. An absorbable scaffold of poly-4-hydroxybutyrate (P4HB), sewn into the lower breast as a sling. It resorbs over roughly 12 to 18 months and leaves a layer of collagen behind that is intended to keep supporting the tissue.
TIGR Matrix. The most modern scaffold: a fully synthetic, long-term resorbable mesh knitted from two fibre types. A fast-resorbing fibre gives strength during the first weeks of healing; a slow-resorbing fibre keeps supporting the tissue for many months and is fully absorbed over about three years, by which time the patient’s own collagen has taken over.
ADM (acellular dermal matrix). A biological sheet of processed human or porcine dermis from which the cells have been removed, so it integrates as a scaffold for the patient’s own tissue. It is used mainly in breast reconstruction and complex revision, and is the most expensive of the options.
| Autologous (Dr. Michels) | GalaFLEX (P4HB) | TIGR Matrix | ADM | |
|---|---|---|---|---|
| Nature | Own fascia and muscle + permanent sutures | Absorbable synthetic scaffold | Long-term resorbable synthetic mesh, two fibre types | Biological dermal sheet |
| Foreign body | None | Until resorbed | Until resorbed | Until integrated |
| Support duration | Permanent — living tissue | Resorbs over ~12–18 months; collagen layer remains | Strength for months; fully absorbed over ~3 years | Integrates into own tissue |
| Palpability | Not felt as separate from the breast | Can be felt in thin patients before resorption | Can be felt in thin patients before resorption | Occasionally felt as a firm layer |
| Regulatory status for cosmetic lift | Not applicable — no device | Off-label in most jurisdictions | Off-label in most jurisdictions | Off-label in most jurisdictions |
| Material-specific complications | None beyond the underlying operation | Seroma, delayed healing, rare exposure or infection | Seroma, delayed healing, rare exposure or infection | Seroma, red-breast reaction, higher cost |
| Device cost | None | Added to surgery | Added to surgery | Highest |
Scaffold materials have their advocates and their published results, and in the right hands they are legitimate tools — particularly where a patient’s own tissue is genuinely too thin to build from. Dr. Michels’ position is a preference for biological integration: support built from the patient’s own tissue carries no foreign-body risk, nothing to resorb or to be felt, and no additional device cost — and it has proved durable in his practice across lifts, augmentations, revisions and explant-lifts.
Which operations include an internal bra?
The internal bra is a component of an operation, not an operation of its own. Dr. Michels incorporates it into:
- Breast lift (mastopexy) without implants — the sling supports the reshaped tissue; where the lower breast is generous, an auto-augmentation repositions your own tissue higher to restore upper-pole fullness with no implant.
- Breast lift with implants — the sling supports the tissue and the fold sutures support the implant, so neither settles.
- Breast augmentation — fold reinforcement prevents bottoming out, particularly with larger implants or a soft, mobile fold.
- Breast reduction — the remaining tissue is supported from within, helping the shape last.
- Breast implant revision — implants that have dropped below the fold, drifted outwards or merged in the middle are repositioned and the pocket rebuilt with permanent internal sutures (capsulorrhaphy with the Internal Bra technique) — see the dedicated section below.
- Explant-lift — after breast implant removal, the sling is what allows the remaining tissue to hold a natural shape without an implant providing structure.
How is the internal bra used in breast implant revision?
Revision surgery corrects a problem with a previous augmentation, and it is where the internal bra proves its value most clearly. Almost every implant malposition is a support failure: the fold or the side wall of the pocket has stretched and no longer holds the implant where it belongs. A revision that simply moves the implant back into the same stretched pocket fails the same way. Dr. Michels rebuilds the pocket with permanent internal sutures (capsulorrhaphy) that close off the over-stretched portion and recreate a firm shelf at the fold — and, where the tissue is weak, raises flaps of the patient’s own fascia to reinforce it. The repositioned or exchanged implant then rests on a structure built to carry its weight for the long term.
| Problem | What it looks like | Correction with the Internal Bra |
|---|---|---|
| Bottoming out | Implant below the fold; nipple looks too high; long, over-full lower breast | Lower capsulorrhaphy; fold rebuilt with permanent sutures; often a smaller or lighter implant |
| Lateral displacement | Implants fall towards the armpits lying down; cleavage widens | Lateral capsulorrhaphy to close the outer pocket; implant width matched to the chest |
| Symmastia | Pockets merge across the midline; cleavage lost | Medial capsulorrhaphy to re-establish the cleavage; narrower implant; sometimes a change of plane |
| Double bubble | A visible second crease across the lower breast | Lower tissue released or adjusted; implant repositioned; new fold reinforced |
| Capsular contracture | Breast firm, high, round or painful | Total (or en bloc, when indicated) capsulectomy; exchange for a smooth or nano-textured implant; usually a change to dual plane; fold reinforced |
| Rupture | Silent in cohesive silicone (found on imaging); deflation in saline | Implant and capsule removed; exchange with fold support, or explant |
| Rippling | Folds of the shell visible through thin tissue | More cohesive implant, dual-plane coverage, fat transfer over the edge |
| Sagging around a good implant | Nipple has dropped while the implant stays high (waterfall) | Mastopexy with the autologous Internal Bra, with or without implant exchange |
| Size change | Wanting smaller, lighter or differently shaped implants | Exchange with pocket adjustment and fold reinforcement for the new implant |
Corrections are frequently combined — a contracture release with a size change and a lift, for instance — in a single operation. Implants used in revision are premium cohesive silicone with smooth or nano-textured surfaces (Motiva, Mentor, Polytech), chosen by measurement and 3D simulation; older textured devices can be exchanged for modern ones at the same time. Many revision patients had their first augmentation elsewhere, in the UAE or abroad: bring any implant card or operative records you have, and where none exist, ultrasound or MRI identifies the implant and the state of the capsule before surgery. Revision typically takes one and a half to three hours and follows the same recovery as a lift or augmentation, with the six-week protection period mattering more, because the internal sutures that rebuild the fold and pocket must heal under no tension. Patients who prefer to have their implants out permanently follow the explant path; the guide to when implants need replacing explains how to tell the two decisions apart.
Who benefits most — and who does not need it?
The internal bra matters most where the tissue is least able to hold a lift on its own:
- Significant sagging (grade 2–3 ptosis) with a nipple at or below the fold
- Thin, stretched or inelastic skin after pregnancy, breastfeeding or major weight loss
- Heavy breasts, where gravity works hardest
- Larger implants, or a soft fold that would let an implant descend
- Revision cases where a previous lift or augmentation has settled early
- Lifts after implant removal, where the breast has been stretched by an implant for years
In a younger patient with excellent elasticity, a small breast and mild sagging, a well-performed lift holds well on its own and the internal bra adds comparatively little. Dr. Michels will say so at the consultation rather than sell a technique that your anatomy does not require.
How long does an internal bra last?
Because the autologous sling is your own living tissue, it does not resorb, wear out or need replacing — it becomes a permanent part of the breast. Scaffold materials behave differently: GalaFLEX resorbs over roughly 12 to 18 months and TIGR Matrix over about three years, after which the result depends on the collagen layer they leave behind. What no internal bra can do is stop time. Skin continues to lose elasticity with age; pregnancy and significant weight change still affect the result. What changes is the rate: a breast supported from within holds its shape, upper-pole fullness and fold for far longer than one held by skin alone. No surgeon can honestly call a lift permanent; a lift with an autologous Internal Bra, a stable weight and a healthy lifestyle is expected to remain good for many years and to age gracefully rather than drop early.
What does the consultation involve?
Dr. Michels examines the breasts, grades the degree of sagging by the nipple’s position relative to the fold, assesses skin quality and thickness, and measures the chest. 3D simulation shows the expected shape of a lift alone, a lift with implants or a hybrid lift with fat transfer on your own body. Whether the internal bra is included — and in which form — is decided from that assessment and explained plainly, together with the incision pattern your degree of sagging requires.
What about safety, anaesthesia and recovery?
All surgery takes place under general anaesthesia in the JCI-accredited theatres of Elyzee Hospital in Abu Dhabi, with board-certified anaesthesiologists monitoring you throughout. Ultrasound-guided nerve blocks are placed before you wake, so the first days are comfortable without heavy painkillers, and the surgery is performed without drains.
The internal bra does not change the recovery of the underlying operation:
| Phase | What to expect |
|---|---|
| Days 1–3 | Tightness and moderate discomfort, easily controlled; compression bra day and night |
| Week 1–2 | Desk work and driving once off prescription painkillers (typically day 5–7) |
| Weeks 3–4 | Light cardio such as stationary cycling |
| Weeks 4–6 | Compression bra can be stopped; breasts soften |
| 6 weeks + | Unrestricted exercise; final settled shape over 3–6 months |
Because the support is internal and tension is removed from the skin, incisions heal under less stretch — which, together with glue closure, favours the finest possible scar over the 12 to 18 months of maturation.
What are the risks?
The internal bra shares the risks of the operation it is part of — bleeding, infection, seroma, changes in nipple sensation, asymmetry, delayed healing — and these are minimised with meticulous technique and a hospital setting. The autologous version does not add the material-specific risks of foreign-body infection, exposure or palpability, because there is no scaffold. Occasionally the internal sutures cause a temporary pulling sensation or can be felt in very thin patients; this settles as healing completes.
Why choose Dr. Paulo Michels?
Dr. Michels is a Brazilian board-certified plastic surgeon with over 18 years of experience and a member of ISAPS, ASPS and the Brazilian Society of Plastic Surgery, awarded the Gold Medal for Best Body Contouring at the World Plastic Surgery Olympiads 2025. Breast surgery — augmentation, lift, reduction, revision and explant — is central to his practice, and the autologous Internal Bra is part of how he plans results to last. Patients from Dubai and across the UAE are seen at Elyzee Hospital in Abu Dhabi, with consultation, imaging, surgery and follow-up grouped to minimise travel.
Questions, answered
Internal Bra Technique in Abu Dhabi — your questions
What is an internal bra?+
The internal bra is a patient-friendly name for any technique that creates a supporting structure inside the breast — beneath the tissue or around an implant — so that the lifted breast or the implant is held in position rather than relying on skin alone. It works like the underwire and band of a bra, but from the inside, and it is done during a lift, augmentation, reduction, revision or explant rather than as a stand-alone operation.
What does an internal bra actually do?+
Skin stretches; a support layer does not. After a breast lift the reshaped tissue would normally be held only by the tightened skin envelope, which loosens again with time, gravity, weight change and pregnancy. An internal bra transfers that load to a deeper, stronger layer — either your own fascia and muscle, or a mesh scaffold — so the upper-pole fullness and nipple position last longer and the breast fold stays defined.
Is the internal bra a product or a technique?+
A technique. The internal bra is the surgical principle of building a supporting layer inside the breast; GalaFLEX, TIGR Matrix and ADM are materials some surgeons use to build it, and the patient's own fascia and muscle is another. Asking a surgeon 'do you do the internal bra?' is really two questions: whether they build internal support at all, and what they build it from.
What materials are used for an internal bra?+
Four options exist. The patient's own tissue — a sling of fascia and muscle plus permanent fold sutures — is the autologous approach Dr. Michels uses as standard. GalaFLEX is an absorbable P4HB scaffold that resorbs over roughly 12 to 18 months. TIGR Matrix is the most modern scaffold: a fully synthetic, long-term resorbable mesh with two fibre types — one gives strength for the first weeks, the other keeps supporting for many months before being fully absorbed over about three years. ADM (acellular dermal matrix) is a biological sheet of processed human or porcine dermis, used mainly in reconstruction and complex revision.
Does Dr. Paulo Michels use GalaFLEX or TIGR mesh?+
Dr. Michels' standard Internal Bra is autologous — built from the patient's own fascia and muscle with reinforcing sutures — rather than a scaffold product. He prefers biological integration: the support is living tissue with its own blood supply, cannot be felt, cannot become exposed or infected as a foreign body, does not need to resorb and carries no device cost. Scaffold materials have a legitimate place in breast surgery, particularly where a patient's own tissue is too thin to build from, and their role is discussed honestly at the consultation.
Are GalaFLEX, TIGR Matrix or ADM approved for breast lifts?+
These materials are cleared for soft-tissue reinforcement in general, but no mesh or matrix is specifically approved for cosmetic breast lift or augmentation, and their use in aesthetic breast surgery is considered off-label in most jurisdictions. Reported complications include fluid collection, delayed healing, palpability and, rarely, exposure or infection requiring removal; they also add the cost of the device to the surgery.
Which operations can include an internal bra?+
A breast lift (mastopexy) with or without implants, breast augmentation — where sutures at the fold prevent the implant from bottoming out — breast reduction, revision surgery for implants that have dropped, and explant surgery when a lift is performed after implant removal. It is a component of the operation, not a separate procedure.
Can I have an internal bra breast lift without implants?+
Yes — this is one of its main uses. Many women want a lifted, fuller-looking breast without a foreign body. An autologous Internal Bra mastopexy lifts and reshapes your own tissue and supports it from within, and where the lower breast tissue is generous an auto-augmentation moves it higher to restore upper-pole fullness, giving the projection of a small implant with none.
How long does an internal bra last?+
The autologous sling is your own living tissue, so it does not dissolve or wear out — it remains part of the breast for life. What it cannot do is stop ageing: skin continues to lose elasticity, and pregnancy or significant weight change will still affect the result. What it changes is the rate of settling: the breast holds its shape and fold far longer than a lift held by skin alone. Scaffold materials, by contrast, resorb — GalaFLEX over roughly 12 to 18 months, TIGR Matrix over about three years — and rely on the collagen layer they leave behind.
Does an internal bra make a breast lift permanent?+
No lift is permanent, and any surgeon who promises that is over-promising. A lift resets the clock; the Internal Bra slows it down. With a stable weight and no further pregnancies, results supported by an autologous internal bra are expected to remain good for many years, with the breast ageing gracefully rather than dropping early.
Who benefits most from an internal bra?+
Patients whose tissue is least able to hold a lift on its own: significant sagging (grade 2–3 ptosis), stretched or thin skin after pregnancy or weight loss, heavy breasts, larger implants, revision cases where a previous lift has dropped, and women having a lift after implant removal. In a young patient with excellent elasticity and mild sagging it adds less — and Dr. Michels will say so.
Can an internal bra fix implants that have bottomed out?+
Yes. Bottoming out — the implant sliding below the natural fold — is a support problem, and reinforcing the fold with permanent internal sutures (capsulorrhaphy with the Internal Bra technique) rebuilds the shelf that holds the implant in place. This is a routine part of revision surgery for dropped implants.
What is breast implant revision with the internal bra technique?+
Revision corrects a problem with a previous augmentation — bottoming out, implants drifting sideways, symmastia, double bubble, capsular contracture, rupture, rippling or a size the patient no longer wants. Most malposition is a support failure: the pocket has stretched. Dr. Michels rebuilds the pocket and fold with permanent internal sutures (capsulorrhaphy) and, where the tissue is weak, flaps of the patient's own fascia, so the repositioned or exchanged implant rests on a structure built to carry its weight — the reason the correction holds.
What is capsulorrhaphy?+
Capsulorrhaphy is the surgical tightening of the pocket around an implant with rows of permanent internal sutures. It is the core manoeuvre for bottoming out, lateral displacement and symmastia: the over-stretched part of the pocket is closed off and the implant returned to its correct position. Dr. Michels performs it with the Internal Bra principle so the repair carries the implant's weight for the long term.
What is symmastia and how is it corrected?+
Symmastia — sometimes called uniboob — is when the implant pockets have merged across the midline, so the implants touch or the skin lifts off the breastbone. It is corrected by closing the medial pocket with permanent sutures to recreate the cleavage, often with a narrower implant and a change of plane, and the repair is secured with the Internal Bra principle to prevent recurrence.
Do I need a mesh for my revision?+
Usually not. Dr. Michels rebuilds the pocket from the patient's own tissue rather than inserting GalaFLEX, TIGR Matrix or an acellular dermal matrix. Scaffold materials have a place when the native tissue is genuinely too thin to hold a repair; if that applies to you it is discussed openly at the consultation, including the off-label status and the additional cost of the material.
Can Dr. Michels revise breast surgery done by another surgeon or abroad?+
Yes. A large share of revision patients had their first augmentation elsewhere — in the UAE or overseas — and no longer have access to that surgeon. Bring any implant card or operative records you have; where none exist, ultrasound or MRI identifies the implant and the state of the capsule before surgery, and the revision is planned from that.
Is an internal bra painful?+
The internal bra does not add meaningful pain to the underlying operation. Patients feel the tightness of the lift or augmentation for the first days, which is well controlled with ultrasound-guided nerve blocks placed before you wake and simple oral medication afterwards.
Does an internal bra change the recovery?+
No. Recovery follows the main procedure — desk work in 5 to 7 days after a lift, light cardio at 3 to 4 weeks, unrestricted exercise at about 6 weeks, compression bra day and night for the first 4 to 6 weeks. Because the support is internal and tension is taken off the skin, the incisions heal with less stretch, which is good for the final scar.
Can you feel an internal bra?+
An autologous internal bra is made of your own fascia and muscle and cannot be felt as anything separate from the breast. Scaffold materials can sometimes be felt as a firm layer during the months before they resorb, particularly in thin patients.
Are the scars different with an internal bra?+
No additional incisions are needed. The sling is created through the same incision as the lift or augmentation — around the areola, vertical lollipop or anchor, depending on the degree of sagging — and the skin is closed with cyanoacrylate surgical glue for the finest possible scar.
How is the autologous Internal Bra different from the 'internal bra' sutures used in breast augmentation?+
They are two parts of the same principle. In augmentation, the Internal Bra is a set of permanent sutures reinforcing the inframammary fold so the implant cannot bottom out. In a lift, it is a full sling of fascia and muscle supporting the reshaped tissue, plus the fold sutures. Dr. Michels uses whichever version — or both — the operation requires.
How much does an internal bra add to the cost?+
Because the autologous Internal Bra uses your own tissue, there is no device cost — unlike GalaFLEX, TIGR Matrix or ADM, which add the price of the material to the surgery. Costs are individual and quoted after consultation once the plan is defined; no fixed price list is published.
Where is the internal bra breast lift performed?+
All surgery takes place at Elyzee Hospital in Abu Dhabi, a fully licensed private hospital with JCI-accredited theatres, under general anaesthesia. Patients from Dubai and across the UAE are seen there routinely, with visits grouped to reduce travel.
Can the internal bra be combined with fat transfer?+
Yes. In a hybrid lift, a small implant or fat transfer restores volume while the Internal Bra supports the reshaped tissue — the combination that produces the most natural, long-lasting result for deflated, sagging breasts after pregnancy or weight loss.
What are the risks?+
The internal bra shares the risks of the underlying breast operation — bleeding, infection, seroma, altered nipple sensation, asymmetry, delayed healing. The autologous version does not add the material-specific risks of exposure, infection of a foreign body or palpability, because there is no scaffold. Rarely, the internal sutures can be felt or cause a temporary pulling sensation that settles as healing completes.
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