Expertly WRITTEN By
Dr. Rocco Piazza, MD, FACS
Board-Certified Plastic Surgeon & Austin's Leading Specialist in Breast Revision and Internal Bra Support.
The Case at a Glance
Patient: Woman, Age 47
Desired Goal: Softer, lower shape with restored lower pole fullness and cleavage
Implant: Natrelle Inspira SoftTouch® (Full Projection)
Size: 450cc
Technique: Implant Exchange + GalaFLEX Internal Bra + Fat Transfer (60cc right, 62cc left)
Support Note: Because the GalaFLEX scaffold reinforces the lower pole from the inside rather than relying on stretched skin alone, the corrected implant position is held while the body builds its own collagen framework around it — so a result that looks right at six weeks still looks right years later.
Twenty years is a long time for a breast implant. This patient's saline implants were placed in her twenties, and for most of that time they did exactly what she wanted. But breasts change, implants age, and tissue that has carried a device for two decades does not behave the way it did on day one.
By the time she came to The Piazza Center, the problem was specific and she could describe it precisely: her implants sat too high. All the volume had migrated to the top of the breast, the lower pole was empty, and the shape read as obviously augmented rather than naturally full. She wanted something softer. She wanted fullness underneath rather than above. And she wanted cleavage — but not the crowded, pushed-together look. She was clear that she still wanted real separation between the breasts.
Why 20-Year-Old Implants Start Riding High
This is one of the most common reasons patients come in for breast revision in Austin, and it is almost always misunderstood. Patients assume the implant "moved up." Usually it didn't. What happened is that the skin and soft tissue of the lower breast stretched under two decades of gravity and weight, while the capsule around the upper portion stayed tight. The implant stayed put; the breast fell away from underneath it.
Saline compounds the effect. Saline implants are firmer and less forgiving in the way they fill a pocket, and they tend to hold a rounder upper-pole shape rather than settling into a natural teardrop. Two decades on, that produces exactly what this patient described: full up top, hollow below.
Simply putting in a bigger implant does not fix this. A larger device in an already-stretched lower pole gets you more volume in the wrong place and accelerates the same problem. The position has to be corrected structurally.
The Fix: An Internal Bra
This is where GalaFLEX changes the conversation.
GalaFLEX is a surgical scaffold made from poly-4-hydroxybutyrate (P4HB), a resorbable material that gets placed inside the breast to reinforce the lower pole and hold the implant where the surgeon puts it. Patients know it by its nickname: the internal bra.
The important thing about GalaFLEX is what happens to it over time. It is not a permanent mesh that stays in the body indefinitely. It is a temporary framework. Over roughly 12 to 18 months the scaffold is gradually absorbed, and as it goes, the body lays down its own organized collagen along the same lines. What remains is not plastic — it is the patient's own reinforced tissue, stronger than it was before surgery. Published outcomes in Aesthetic Surgery Journal have tracked this collagen response in breast surgery patients out past five years.
For a revision like this one, that is the difference between a result that looks good at six weeks and one that still looks good at six years. Without internal support, a corrected implant position in stretched tissue tends to drift back toward where it came from. GalaFLEX gives the correction something to hold onto.
Clinical Results: A Lower, Softer, More Natural Breast
Tap any image below to reveal this patient's actual result — a lower implant position, restored lower pole fullness, and improved cleavage with natural separation preserved. See the full gallery case here.
The Difference: 450cc Natrelle Inspira SoftTouch
The implant choice mattered as much as the support. Dr. Piazza selected 450cc Natrelle Inspira SoftTouch full projection silicone gel implants — a cohesive gel designed to sit between the two extremes patients usually get offered. Firmer gels hold shape beautifully but can feel unnatural to the touch. Softer gels feel real but lose definition over time. SoftTouch is formulated to land in the middle: enough cohesivity to maintain a defined lower pole, enough give to move and feel like breast tissue.
For a patient coming out of twenty years with saline, the tactile difference is usually the first thing she notices — well before she notices the shape. If you are weighing options, our guide to breast implant options in Austin breaks down how gel cohesivity, projection and base width interact.
"Revision patients almost never need a bigger implant. They need the implant they have put back where it belongs, and they need the tissue to hold it there. That is what the internal bra does — it lets me correct position instead of just adding volume." — Dr. Rocco Piazza
Why Fat Transfer Was Part of the Plan
An implant exchange fixes volume. GalaFLEX fixes position. Neither one fixes contour — and after two decades with implants, contour is usually where the giveaway lives.
Tissue thins over the upper and inner breast. That thinning is what produces visible implant edges, rippling along the cleavage line, and an abrupt transition where the breast meets the chest. No implant can correct it, because the problem is the covering, not the filling.
Dr. Piazza harvested fat from the groin and outer thighs and grafted it along the medial breast — 60cc on the right, 62cc on the left. Placed there, it does two jobs: it softens the transition at the cleavage so the breast reads as continuous with the chest, and it adds a layer of natural padding over the implant edge. This is the detail that let her have improved cleavage without the crowded look she was worried about. You can read more about how we use fat transfer in breast augmentation as a finishing technique rather than a primary one.
Three problems, three tools, one two-hour operation.
Breast Implant Exchange & GalaFLEX FAQ
How long do breast implants actually last?
There is no expiration date, and implants do not need to be replaced on a schedule if nothing has changed. What changes is the breast around them. Most patients who come in for revision are responding to shape and position changes in their own tissue — as this patient was at twenty years — rather than to a problem with the device itself.
What is an internal bra, and is GalaFLEX permanent?
"Internal bra" is the common term for a surgical scaffold placed inside the breast to support the lower pole. GalaFLEX is not permanent — the P4HB material is fully resorbed over roughly 12 to 18 months, and the body replaces it with its own collagen along the same framework. The support that remains is your tissue, not an implanted mesh.
Do I need a breast lift, or will an implant exchange be enough?
It depends on where your nipple sits relative to the breast crease. If the position is still good and the issue is volume distribution and lower pole support, an exchange with internal support can be enough — as it was here. If the nipple has descended significantly, a breast lift is likely part of the plan. This is a decision that requires an in-person exam.
Can I switch from saline to silicone?
Yes, and it is one of the most common requests in revision surgery. Modern cohesive gel implants feel substantially more like breast tissue than saline, and they produce a more natural upper-pole slope. The exchange is typically done through the existing scar.
Does adding GalaFLEX make recovery longer?
Not meaningfully. The scaffold is placed during the same procedure and does not add a separate incision or a separate recovery track. Most of what shapes recovery in a revision is the pocket work itself. Dr. Piazza reviews an individualized timeline at your consultation.
Individual results vary. Photographs are of an actual patient of The Piazza Center, published with consent. This article is for educational purposes and does not constitute medical advice. A consultation with a board-certified plastic surgeon is required to determine candidacy.
Are Your Implants Sitting Too High?
Dr. Rocco Piazza is Austin's specialist in breast revision with internal bra support. See what an implant exchange could do for your shape.
Dr. Rocco Piazza II
Board-Certified Plastic Surgeon
Dr. Piazza is a board-certified plastic surgeon practicing in Austin, TX. He specializes in aesthetic and reconstructive surgery with a focus on natural results.
