A Five Year Review of Poly-4-Hydroxybutyrate Mesh in Cosmetic Breast Surgery

Goals/Purpose: The use of P4HB Mesh (ie. Galaflex) in cosmetic breast surgery is beneficial due to its ability to support the lower pole of the breast. It provides a scaffold to help ingrowth of tissue to prevent bottoming out of the breast from weight of breast tissue or implant. It has shown to be both safe and affordable for patients. The purpose of this study is to review the use of P4HB mesh in primary and secondary breast procedures over 5 years.

Methods/Technique: A retrospective review from January of 2015 through October 2020 was performed for all patients that underwent placement of P4HB mesh in primary and secondary breast surgeries by three surgeons. Review of the indications for use of mesh was evaluated as well as complications and overall outcomes.

Results/Complications: During the 5-year period, P4HB mesh was used in 161 patients. 57% of patients underwent mesh placement for primary breast procedures. Primary breast surgeries included mastopexy, augmentation mammoplasty, reduction mammoplasty, and augmentation mastopexy. 43% of patients underwent mesh placement for secondary revisional breast procedures. Secondary breast procedures included correction of malposition, symmastia, stretch deformities, and capsular contracture. The overall complication rate was 20% and included hematoma, recurrence of malposition related to mesh malposition, infection, hypertrophic scarring and wound dehiscence. Of these complications, 39% of the complications were related to the mesh and included recurrent malposition and exposed mesh. Secondary procedures were required for 92% of patients who experienced a complication related to mesh.

Conclusion: The use of P4HB can be used successfully in primary and secondary breast procedures with predictable long-term results and minimal risk of complications. Mesh can be an excellent addition to primary breast procedures to decrease risk of inferior malposition or stretch deformity. Mesh can also be used for secondary breast procedures to correct malposition and stretch deformities. Patients undergoing secondary procedures are at higher risk of complications needing revisional surgery and should be properly counseled.