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This was also plaguing Dr. Rowe, who responded to my initial consultation with multiple surgical plans. “One of the key things that I try to ascertain when I’m examining a patient: what are their true expectations and, more importantly, are they realistic for the patient?”
When Dr. Rowe first opened his private practice in 2004, he was routinely implanting 500 and 600cc implants—for reference, one cup size is around 250cc. With larger implants dropping faster, creating sagging, he says women have trended smaller in the last five years. Fat transfer enhancements, popular among those seeking natural-looking breasts, can calcify into hard lumps and be mistaken for cancer during mammography—resulting in additional surgery. The complications and shelf lives associated with implants have also become more well-known: follow-up implant removal or replacement surgeries after 10 years or sooner, and ruptured implants need to be replaced in up to 17.7% percent of patients after 6 or 10 years (the rupture rate after revision augmentation is between 2.9% and 14.7%). Breast implant illness is a controversial topic—it’s a term patients came up with, rather than a medical diagnosis; there’s a lack of data on the topic; and no real agreement about what the symptoms are, though patients tend to name hard-to-track ones, like fatigue, joint pain, brain fog, rash, memory loss—but the FDA and many doctors agree there’s still much to learn, Grant Stevens, the president of the American Society for Aesthetic Plastic Surgery (ASAPS) and a clinical professor of plastic surgery at the Keck School of Medicine of USC, previously told to Allure.
Still, the promise of built-in cleavage was tempting. I wanted to go braless without insecurity. Wear plunging dresses without experimenting with endless sticky cutlets. I didn’t want to tug up my breasts in tight tops. At the same time, I didn’t want to go bigger, and I didn’t want to possibly undergo multiple surgeries on my breasts as I aged. My heart just wasn’t in the implants.
“Whereas I used to do a lot of breast implant mastopexies—where you put in the implants at the same time—today, I’m probably doing a larger number of mastopexies [breast lifts] alone,” he says.
Post-consultation, the options Dr. Rowe offered me were a mastopexy with a small implant or a mastopexy with an internal bra. The internal bra is a lesser-known procedure that originated in the ‘80s, reaching wider awareness more recently, Rowe says, with the help of a rebrand and big marketing push. Originally, the internal bra was a kind of cone shape (picture Madonna) created from a Gore-tex mesh. Over time, there were claims the mesh may have been obscuring mammography, and insurance companies began rejecting claims for mammograms if the patient had an internal bra. That’s where Galaflex came in. A new internal bra material first implemented around 2016, it’s best described as an absorbable mesh sewn into the chest wall.
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