BACKGROUND: Relying on soft tissues with low structural strength to provide long-term support of the breasts following aesthetic mammoplasty may be inadequate in many instances. To address the inherent weakness of tissues still present after surgery, use of synthetic non-autologous additional tissue reinforcement has been described. The current review is aimed at analyzing available evidence about safety and effectiveness of mesh support in various reduction mammoplasty, mastopexy, or augmentation-mastopexy. METHODS: An advanced PubMed and Medline search was conducted to identify clinical studies about the use of synthetic mesh in aesthetic breast surgery. An additional search of breast symmetrization and synthetic mesh was also conducted. Ten studies were identified and judged to be relevant to this review. RESULTS: Retrieved studies were relatively few, characterized by marked heterogeneity, lack of well-defined outcome end points, poor outcome measures, and inherent bias in outcome documentation providing low level of evidence. CONCLUSION: Despite reported relative safety and some promising results, available data indicate that meshes do not effectively prevent recurrent ptosis and bottoming out; they may not be superior to described techniques with superior pedicle and hammocks or "balcony" flaps. Well-conducted studies are yet to be conducted comparing internal bra technique to procedures with innovative autologous tissue support. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .