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Internal Bra Surgery With GalaFLEX™: 10 Frequently Asked Questions

Posted On: October 14, 2026 Author: The Office of Dr. Stuart Linder Posted In: Internal Bra Surgery

Woman in a gray bra holding her breast

This article answers ten common questions patients ask Dr. Stuart Linder about internal bra surgery and the use of GalaFLEX™ for breast support and reconstruction.

9 Min Read:

Table of Contents

1. What Is an Internal Bra in Breast Surgery?

An "internal bra" is a surgical technique used to provide additional support to the breast when the patient's own tissues or breast capsule may not provide adequate structural support. It may involve an acellular dermal matrix graft or a biosynthetic material that is positioned within the breast to provide tissue coverage, reinforce weakened tissue, or help reposition the breast pocket.

In my Beverly Hills practice, I perform internal bra procedures regularly for both cosmetic and reconstructive breast surgery. I most commonly use an internal bra when there is significant dehiscence, or separation, of the inframammary fold or when a patient has developed bottoming out of the breast.

When the breast capsule is adequate, I may create a capsular sling to provide additional support. When the capsule is thin, weak, or inadequate—particularly in patients who have undergone multiple previous breast surgeries—I may use GalaFLEX™ as an additional scaffold to reinforce the inframammary fold. The goal is to help restore the breast fold to a higher, more stable position and provide additional structural support during the healing process.

2. What Is GalaFLEX™ and Why Is It Used as an Internal Bra?

GalaFLEX™ is a biosynthetic scaffold made from poly-4-hydroxybutyrate (P4HB). It is designed to provide temporary structural support and gradually resorbs over time. GalaFLEX™ is available in different sizes and configurations, including three-dimensional designs with tabs. I use GalaFLEX™ as an internal scaffold in selected patients who need additional support of the breast tissue or inframammary fold. The material can be particularly useful when a patient's own breast capsule does not provide sufficient strength to reconstruct or elevate a weakened fold.

These features can facilitate positioning and suturing during complex breast revision procedures.

However, when used to support breast reconstruction or reinforce the inframammary fold in these applications, GalaFLEX™ is being used off-label, which is an important distinction for patients to understand before undergoing breast surgery.

3. How Does GalaFLEX™ Provide Support to the Breast?

GalaFLEX™ provides temporary structural support while the patient's own tissues heal and remodel. When I use GalaFLEX™ to reinforce the inframammary fold, I may secure the lower portion of the scaffold to the periosteum of the rib and attach the superior portion to the breast capsule and/or breast tissue. This can help elevate and stabilize a weakened breast fold.

Over time, the P4HB material gradually resorbs. The goal is for the patient's own tissue to incorporate into and remodel around the scaffold, creating a collagen-based tissue framework that can provide longer-term support after the material itself has been absorbed. GalaFLEX™ is therefore not a permanent implant. Its role is to provide temporary reinforcement while the body's natural healing and tissue-remodeling process takes place.

4. Who Is a Good Candidate for an Internal Bra With GalaFLEX™?

GalaFLEX™ can be useful in appropriately selected patients who require additional structural support during breast surgery. It may be particularly helpful in patients who have undergone multiple breast revision procedures and have a thin or inadequate capsule. In these situations, there may not be enough strong capsular tissue to create an effective capsular sling to support the inframammary fold.

Reconstructing and elevating a dehisced inframammary fold can be a technically demanding procedure. In my practice, I may use several techniques depending on the patient's anatomy.

First, if there is a thick and substantial capsule, I may create a capsular sling by elevating the capsule from the rib, repositioning it superiorly, and removing redundant capsule as necessary. Second, I may use GalaFLEX™ as an additional scaffold. The material can be secured to the periosteum of the rib and then attached superiorly to the capsule and/or breast tissue to help maintain the fold in its elevated position.

Third, I may close the dead space using a three-point suture technique that helps bring the superior flap, inframammary fold, and inferior flap together.

The appropriate technique depends on the patient's tissue quality, previous surgeries, breast anatomy, and the condition of the inframammary fold.

5. Can GalaFLEX™ Be Used to Reinforce the Inframammary Fold?

Yes. Reinforcing the inframammary fold is one of the applications for which I use GalaFLEX™ in selected breast revision cases.

For example, I may use a GalaFLEX™ or GalaFLEX™ 3D scaffold measuring approximately 5 by 15 centimeters, depending on the patient's anatomy and the amount of fold reconstruction required. The material can be shaped to fit along the inframammary fold. I may secure the inferior portion to the periosteum of the rib and the superior edge to the breast capsule and/or breast tissue. The goal is to elevate and reinforce the inframammary fold when it has become weakened, displaced, or disrupted.

6. Can an Internal Bra Be Used During Breast Implant Revision Surgery?

Yes. In fact, internal bra techniques are most commonly used during breast revision surgery. Patients undergoing revision may have weakened breast tissue, a stretched implant pocket, an inadequate capsule, or an inframammary fold that has moved from its desired position. In these situations, simply repositioning the implant may not provide sufficient long-term structural support. An internal bra can be considered as an additional method of reinforcing the tissues.

I have also used this technique in selected primary breast lift patients when additional support of the inframammary fold is necessary, including situations where the fold has become disrupted following previous augmentation-mastopexy surgery.

7. Can GalaFLEX™ Be Used With a Breast Lift or Mastopexy?

Yes. I use GalaFLEX™ in conjunction with breast lifts and mastopexies when additional structural support is appropriate. This can be particularly useful in patients with significant skin laxity and advanced breast ptosis. For example, when the nipple-areola complex is positioned more than approximately three centimeters below the inframammary fold, a patient may require a more formal breast lift and additional support of the lower breast.

In selected patients, GalaFLEX™ can be incorporated into the procedure to help support and elevate the inframammary fold while the breast is reshaped. The decision to use an internal scaffold is individualized. Not every patient undergoing a breast lift requires GalaFLEX™.

8. Can GalaFLEX™ Be Used During Breast Reconstruction or Explantation?

Yes. GalaFLEX™ may be used during selected explantation and breast reconstruction procedures when additional support of the breast fold is needed. My approach depends on the patient's individual anatomy, the condition of the capsule, the amount of skin laxity, and the degree of fold displacement. For example, if a patient has a very low inframammary fold after breast implant removal, I may elevate the existing capsule or create a capsular sling when appropriate. GalaFLEX™ can then be used as an additional scaffold to reinforce the reconstructed fold. This can be particularly relevant in patients whose tissues have been stretched or weakened by previous implants or multiple breast surgeries.

9. How Is GalaFLEX™ Placed During Breast Surgery?

The exact placement depends on the patient's anatomy and the amount of elevation or reinforcement required. In inframammary fold reconstruction, I typically secure the inferior edge of the GalaFLEX™ scaffold to the periosteum of the rib using sutures, often 2-0 PDS. The superior edge is then secured to the breast capsule and/or breast tissue. The scaffold can be shaped, trimmed, or inlaid as necessary to fit the breast and the area requiring reinforcement.

The goal is to create a stable transition between the rib and the breast tissue while elevating the inframammary fold into the desired position. Because these are complex revision procedures, the exact technique is customized to the patient's breast size, tissue quality, previous surgical history, and degree of fold displacement.

10. What Is Recovery Like After Breast Surgery With an Internal Bra?

Recovery varies from patient to patient and depends significantly on the procedure being performed in addition to the internal bra. Some patients experience relatively little discomfort, while others experience more significant pain during the early recovery period. When GalaFLEX™ is secured to the periosteum of the rib, patients may experience discomfort in that area during the initial healing process.

Another issue some patients notice is that the edges of the GalaFLEX™ may be palpable along the medial or lateral portions of the breast. This can sometimes be noticeable for several months after surgery as the tissues heal and the scaffold becomes incorporated into the surrounding tissue.

Recovery also depends on whether the internal bra is performed with a breast lift, implant revision, explantation, or another reconstructive procedure. I provide specific postoperative instructions based on the individual procedure and monitor the patient during the healing process.

Is a GalaFLEX™ Internal Bra Right for Me?

An internal bra is not a replacement for a breast implant. It is a technique for providing additional internal structural support when a patient's breast tissues, capsule, or inframammary fold require reinforcement. Not every patient needs an internal bra. The decision depends on tissue quality, breast anatomy, previous surgeries, and the specific surgical problem being addressed.

The most important points for patients to understand are:

  • An internal bra provides structural support within the breast.
  • GalaFLEX™ is a biosynthetic P4HB scaffold that can provide temporary support while the patient's tissues remodel.
  • GalaFLEX™ is not permanent and gradually resorbs over time.
  • The inframammary fold is an important area of application, particularly when the fold has become weak, displaced, or dehisced.
  • Patients with multiple previous breast surgeries may benefit from additional support when their capsule is too weak to provide adequate reinforcement.
  • A capsular sling and GalaFLEX™ may sometimes be used together to provide layered support.
  • GalaFLEX™ may be incorporated into breast revision, breast lift, reconstruction, and selected explantation procedures.
  • Patients should understand that these applications of GalaFLEX™ are off-label when used for breast reconstruction/internal-bra purposes.
  • Recovery varies, and patients may experience temporary discomfort or palpability of the scaffold while the tissues heal.

Schedule a Breast Surgery Consultation With Dr. Stuart Linder in Beverly Hills

If you have experienced bottoming out, implant malposition, a weakened or displaced inframammary fold, recurrent breast revision problems, or significant tissue laxity, an internal bra may be one of the surgical options to consider.

During a consultation, Dr. Stuart Linder will evaluate your breast anatomy, skin quality, capsule, inframammary fold, implant history, and previous surgeries. Based on these findings, he can determine whether a capsular sling, GalaFLEX™ reinforcement, breast lift, implant revision, explantation, or another reconstructive technique may be appropriate.

Contact Dr. Stuart Linder's office at (310) 275-4813 or complete our contact form to schedule a consultation and discuss your breast surgery goals.