Early Clinical Experience and Evolving Techniques with the Use of Poly-4-Hydroxybutyrate (P4HB) in Aesthetic Breast Surgery

Goals/Purpose: The desire to achieve lasting outcomes by enhancing the structural integrity of breast parenchyma has led to the development and use of a variety of meshes and scaffolds during aesthetic breast surgery. Poly-4-hydroxybutarate (P4HB, GalaFlex®, Lexington MA) has increased in use among plastic surgeons yet no standard technique of placement has been established. The goal of the authors is to evaluate and describe the long-term outcomes with the use of P4HB in a variety of evolving techniques and procedures in aesthetic breast surgery.

Methods/Technique: A retrospective chart review for all patients undergoing breast surgery at CaloAesthetics® with use of poly-4-hydroxybutyrate (P4HB) between January 2016 to December 2023 was performed. Surgical indications, procedure type, location of mesh placement, complications, and patient demographics were collected and reviewed.

Results/Complications: A total of 376 patients were included during the 8-year study period. The average patient age and BMI were 41.8 and 25.1 respectively. The mean follow-up time was 3.5 years (range 1-8 years). The most common indication for use of P4HB was breast ptosis. The complication rate was 10.9% with most complications taking place in patients undergoing secondary breast surgery. Temporary mesh palpability was the most common complication which did not require revisions.

Conclusion: This study evaluates our practice’s early clinical experience and long-term outcomes with the use of P4HB in a variety of aesthetic breast procedures and multiple approaches to utilization. This study examines the largest cohort of patients undergoing utilization with P4HB with the longest average follow-up period. P4HB is a safe, effective tool for maintaining soft tissue support in breast surgery and thus limiting the need for revisions and secondary surgeries.