The “Internal Bra” Effect: How SFS Suspension Prevents Bad Scars On Breast after Breast Reduction Surgery
Table of contents
The Problem: Skin Cannot Hold Weight
Estimated reading time: 3 minutes
For decades, standard breast reductions relied on “dermal suspension.” Essentially, surgeons used the skin itself to hold up the weight of the reshaped breast.
The problem? Skin is elastic—it stretches. When you use skin to support weight, it creates high tension on the incision lines.
- The Consequence: High tension leads to “hypertrophic” (thick, raised) scars. In traditional methods, these bad scars occurred in 50% to 55% of patients within 6 months.
- The Droop: Because the skin stretches, the lift often fails over time, leading to a recurrence of sagging.
The Solution: The Superficial Fascial System (SFS)
In April 1999, Dr. Ted Lockwood published a study in Plastic and Reconstructive Surgery introducing a powerful alternative. He argued that surgeons should anchor the breast not to the skin, but to the Superficial Fascial System (SFS).
What is the SFS?
The SFS is a distinct layer of connective tissue that lies just beneath the skin but is much stronger than the skin itself. It is the body’s natural “casing.”
The Lockwood Technique
Instead of sewing the skin tight, Dr. Lockwood used permanent (non-absorbable) sutures to lock the SFS layers together.
- Internal Locking: The weight of the breast is supported by the fascia.
- Tension-Free Skin: Because the fascia is holding the weight, the skin can be draped gently over the top without any tension.
The Results: A Massive Drop in Scarring
The study analyzed 109 patients (218 breasts) operated on in Kansas between 1993 and 1996. The results were dramatic:
- Traditional Methods: 50–55% rate of hypertrophic scarring.
- Lockwood SFS Technique: 3% rate of hypertrophic scarring.
By taking the tension off the skin, the scars remained thin, flat, and faint. Additionally, the “internal bra” created by the SFS suspension resulted in “longer-lasting contour results” that didn’t bottom out as quickly as dermal suspension.
Conclusion
If you are worried about ugly scars or your breasts drooping again after surgery, the “fascial suspension” technique addresses the root cause of both. By using the body’s own connective tissue strength rather than relying on stretchy skin, surgeons can deliver results that are stable, secure, and beautifully healed.
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Frequently Asked Questions (FAQ)
Q: Are permanent sutures dangerous inside the breast?
A: Generally, no. Permanent sutures in the SFS layer are standard in many body contouring procedures (like tummy tucks). They provide the long-term strength needed to resist gravity.
Q: Does this technique take longer to perform?
A: It may take slightly longer than a standard reduction because the surgeon must carefully identify and suture the specific fascial layers, but the long-term scar benefits are significant.
Q: Is this the same as an “Internal Bra” mesh?
A: Not exactly. “Internal Bra” mesh uses a foreign material (like GalaFLEX) to support the breast. The Lockwood technique uses your body’s own natural tissue (fascia) to create that support, avoiding the risks of foreign objects.
Reference
- [1] Lockwood, Ted M.D. “Reduction Mammaplasty and Mastopexy with Superficial Fascial System Suspension.” Plastic and Reconstructive Surgery 103(5):p 1411-1420, April 1999.
- [2] Song, A.Y., et al. “Biomechanical Analysis of the Superficial Fascial System.” Plastic and Reconstructive Surgery, 2006.