The Internal Bra Technique with GalaFLEX

Speaker 1 (00:03):
Welcome to Kind of Beautiful with board certified plastic surgeon, Dr. Tracy Pfeifer, the podcast for women seeking the very best of modern beauty.

Dr. Pfeifer (00:16):
You know, the internal bra is so interesting because the challenge over many, many years and decades has been, you know, how can we lift the breast and keep it lifted, whether we're doing a breast reduction, which also involves a lift of course, or are we doing a lift alone lift with an implant? And there have been so many different ways of trying to approach this because historically speaking, once a breast has sagged, it's always prone to sagging again because of the loss of the recoil of the Cooper's Ligaments. And because the skin itself has lost elastic recoil. So even though you're removing the excess skin and the breast is up and looks great for a year, if you don't do anything else in a year or two, it's gonna sag again, not to the degree that it was before surgery, but once you have your breast lifted, then it's up.

(01:12)
You want it really to stay that way. So over the decades, we've tried many, many different techniques to keep the breast lifted or prolong the longevity of the result. And what a lot of us are doing now is using a material called GalaFLEX, which is an absorbable product. It basically breaks down into carbon dioxide and water. So it's a little flexible mesh material. It kind of looks like a screen that would use, you would use in your windows, but it's not stiff like that. It's very soft and flexible. And right before I close the skin, I put in a piece of GalaFLEX around the lower half of the breast, almost like it's an internal Demi Cup bra. And this is resulting long-term in people having less sagging. And the thinking, at least in my mind, is that even though the GalaFLEX breaks down at about two years, the scar tissue that forms around it is very durable.

(02:18)
It's less stretchy. And you could think of the GalaFLEX as kind of offloading the weight of the breast from the skin in the lower half of the breast, so that that skin has a chance to really heal and shrink and conform before it's subject to kind of stretch forces from the weight of the breast. So I have a patient who really nice young woman, she was going to college, she had a lot of weight fluctuation, so her breasts had stretched and unstretched, and she just was very empty. She didn't have a lot of breast tissue, so her breast didn't weigh a lot, but her skin was very damaged from the stretching, from the weight fluctuations. And so I thought, well, and this is probably 18 years ago, I thought, well, I'm just gonna do a nice lift for her. I'm gonna reposition the nipple where it should be.

(03:12)
I'm gonna shape the breast, get rid of this extra skin so that it's not sagging. And because she has a small breast, like a small B, she doesn't have a lot of weight and it's gonna hold up fine. I don't need to do anything else. Well, she came back in about six months on one of her breaks from college <laugh>, and her breasts were sagging, not to the degree that they were before, but they were still sagging. So I put in a piece of material, and since then she's had two kids with breastfeeding and her breasts have not budged. So I think that these, the use of these materials, which we call, you know, ADMs or support tissues to create an internal bra, I do think helps the longevity of the result. And it's worth considering. It's a little extra cost to you, the patient, but if you think about the cost of doing a revision because you're sagging, again, it's well worth the slight increase in cost to put a piece of GalaFLEX in there.

(04:16)
And I recommend it for all my patients. Even if a patient is having breast augmentation alone, and let's say they wanna put their implant underneath the muscle, putting the GalaFLEX in on the side of the breast can help keep that implant in proper position and help the implant from stretching out the pocket on the side. And then the implant kind of has a tendency to be displaced and sit off to the side instead of in the center directly underneath the breast. So GalaFLEX has a very good safety profile. It's not that expensive, and it really can add a lot to enhance the longevity of your results. The patient that I described, I use pig skin, which is called Strattice. And Strattice is still available. It's currently not being used in, or it's not being marketed for breast surgery, but it is available for use in abdominal wall like hernia repairs and things like that.

(05:15)
So I've tried Strattice, which is very expensive. I've tried AlloDerm, which is human skin. So Strattice is pig skin, AlloDerm is, human skin. And I tried to GalaFLEX, and the GalaFLEX is relatively cost friendly. And for the surgeon, it's very easy to use. It's very easy to place it, it's very flexible, and it conforms to the shape of the breast, and it has a good safety profile. So GalaFLEX is, uh, what I'm using now. When patients come to the office for a consultation regarding a breast lift or a reduction, I like to show them the GalaFLEX and they can see the mesh material for themselves and how soft and flexible and soft it is. And it just makes sense when I explain, oh, this will be inside, it's temporary, lasts about two years, it's super strong, but it's also super soft and it's gonna help hold up the breast for a longer period of time than it would without it.

(06:18)
So it all makes sense to people when they see it. So it's a no-brainer. Sometimes patients are worried if they're gonna see or feel the GalaFLEX. You're definitely not gonna see it. Occasionally you might feel like a little edge, almost like if you were running your finger off the back of your hand, you might feel like a little tendon. It's kind of like that, but it doesn't bother people. It's not all the time. Or maybe it's like 5% of the time somebody will feel it. And if they have really thin tissues, then they're a little more likely to feel the GalaFLEX. But mostly patients are just concerned. I, I feel a little something, is that normal? Is it anything to worry about? I examine them, reassure them. It's the GalaFLEX, nothing to worry about. It's gonna go away. And it, it doesn't bother them. They just wanna make sure that, you know, there's nothing wrong.

(07:06)
Now, using GalaFLEX really doesn't change the patient's experience. If, if I didn't tell the patient that we were using GalaFLEX, she wouldn't know it was there. Really, it takes the surgery a little bit longer to do, maybe about a half hour. But in terms of the recovery restrictions on activities, how the patient feels after surgery, there is absolutely no difference between using GalaFLEX and not using GalaFLEX. GalaFLEX is very powerful. It, it produces beautiful results. The breast definitely stays lifted. From a surgeon's perspective, it's a little bit challenging because it's so effective. You have to make sure that during the surgery, I put the patient upright and secure the GalaFLEX with the patient upright, because where you secure the GalaFLEX is where it's gonna stay. So if you're a novice and you're, you have the patient lying down, the breast tissue is higher on the chest wall when you're lying down than it is when you're vertical.

(08:07)
So if, if the surgeon secures the GalaFLEX with the patient lying down, you put the patient up, the breast is gonna be overly elevated, and that's not going to relax. It's gonna stick like Velcro, wherever you put it. So from a surgeon's standpoint, we just have to be very precise about the patient's position when we're putting it in, and not to make it overly tight. If it's too tight, it will square off the lower portion of the breast. Instead of having a little gentle curve, a little roundness in the lower part of the breast, it'll square it off. So the surgeon has to be aware of these things, and I've been using it for many, many years, so it's really not an issue. My use of GalaFLEX is I suggested for everybody who's having a lift or a reduction. If somebody's having a revision after augmentation, then depending on what the issue is, sometimes I'll suggest it.

(09:02)
So for example, if the pocket has become stretched out and we're trying to reposition the implant, it can be very helpful in those types of cases. If the patient needs a lift with the revision, I would always recommend it in a primary augmentation. If the implant's gonna be underneath the muscle, I will suggest it to help maintain the position of the implant. So it has a lot of uses in breast surgery, and it's very powerful. It's helping us do a lot of things that we weren't able to do before in terms of the longevity of the results and preventing recurrent sagging. Anybody who's interested in looking at before and after pictures can go to my website, dr Pfeifer.com, go to the gallery, and you can look for examples of people who have had mastopexy augmentation, breast lift, breast reduction. And this conversation has inspired me to go back to my gallery and add information for patients who have had GalaFLEX, so that you can tell when you look at the pictures, who has GalaFLEX.

(10:07)
You know, plastic surgery is such an exciting field because we're always innovating and there's always new ideas. We're always trying to improve the experience for our patient, the results for our patients, the longevity of our results for the patients. And GalaFLEX is one of those innovations that's been really impactful. And a new innovation, which we've talked about earlier, is the Brijjits, which is a little device developed by a plastic surgeon, Dr. Eves, great guy. And it's a little plastic dome, like a little clip, kind of like a little bridge, hence the name Brijjit. And you put the applicator on it, and when the applicator's on, it'll flare open the legs, so the bottom of the legs have adhesive on them, and when you put them on and then release it, it does this. So it literally kind of pinches the skin together a little bit, which is basically offloading or taking away the tension along the incision line.

(11:11)
And when your body is healing, it doesn't like tension. So anything that's trying to pull the skin edges apart is gonna lead to a thicker, heavier scar, which makes sense, because if your body is sensing tension, trying to pull the skin apart, it says, well, you know, we're under tension here. We better make a thick, heavy scar to protect ourselves. So when you put the Bridget on and it is taking the tension off that incision, your body's like, well, you know, we don't have to work so hard here. And that's how you end up having these little thin scars that are strong, but they're very, very invisible because they're not wide, they're not thick, they're not raised. And I'm just loving the Bridget. I just love it. He's making another style, which is gonna be a little bit smaller, and we're gonna be able to use it on the peri-areolar incisions as well.

(12:05)
So it's very exciting. And then the third thing that I would say that for me, it's not a new innovation, but optimizing the patient's nutrition in terms of getting good scars, you and drinking Juven twice a day, J U V E N. It has made a fantastic difference. I think these little scars are really super fine and you can hardly see them. So it was developed for people who have trouble healing. For example, diabetics, diabetic patients, let's say they just have a little breakdown on their foot or something, a little open wound on their foot, even though they have good blood flow to the area on the cellular level, diabetics have a very hard time healing. So this product was developed for them to enhance healing in people who are suffering from wounds that are slow to heal, such as diabetics or somebody who has a pressure sore.

(13:04)
And the results were really impressive in this group of patients. So I said to myself, well, if it's good for these patients, maybe it's gonna help my healthy patients as well. And it's so easy to take it, you just drink it. And when I look at these incisions at three weeks, four weeks, sometimes if I have a breast lift with a lollipop pattern scar, and I'm, I'm like looking, I'm like, I did a vertical on you, didn't I? Because you can barely see it. So I highly encourage people who are having any type of surgery, aesthetic, plastic surgery, whatever it is. I would highly encourage everybody to, to get Juven and drink it. You take it for like two weeks, take it a couple days before surgery, and then start taking it every day after surgery for about two weeks. And I think you'll be very happy with it.

(13:52)
And we'll link to all these amazing products in the show notes as terms of scars, we mentioned that I like to use paper tape, which puts pressure on the incisions, which helps the body against sensitive, has enough support, it doesn't need to need to create a thick scar. And when we're done with the tape, we like to switch people over to something called Skinuva, which is a really interesting product that has silicone in it. So we've all heard of silicone gel or silicone strips to put on scars because it helps them heal, it helps them hydrate. But this product is a gel. It has silicone in it, it's got aloe, which is very soothing, it has growth factors, vitamin C. And this is a really nice product to use on the scars once the tape comes off. And that's another thing that's new in the practice and we're recommending to our patients. So definitely also look for Skinuva, S K I N U V A. Uh, there is a product that has no sunscreen, and then they have a choice, which also has SPF in it. And that's good for people who are gonna be out in the sun.

Speaker 1 (15:04):
To learn more, go to kind of beautiful podcast.com or follow Dr. Pfeifer on Instagram at Dr. Tracy Pfeifer, spelled P F E I F E R. Links to learn more about Dr. Pfeifer. And anything else mentioned on today's show are available in the show notes. The Kind of Beautiful podcast is a production of The Axis, T H E A X I S .io.