Page 12 - Read Online
P. 12
®
wall repair, PHASIX knitted mesh (Tepha) demonstrated CONCLUSION
burst strength significantly greater than native tissue at
all points up to one year. As with silk scaffolds, a variety The concept of an implantable internal bra continues to
[42]
of uses for constructs based on PHB have been explored, evolve. Third generation biomaterials designed to act as
including heart valves. Clinical trial results for GalaFLEX ® templates that resorb and initiate tissue neogenesis address
[43]
(P4HB mesh) in breast surgery have not yet been reported many of the issues posed by non-resorbable materials and
but a trial in mastopexy and reduction mammoplasty is acellular matrices, but have only recently become widely
ongoing. available and less is known about complication rates and
best practices. As indications become better defined and
A composite mesh comprised of fast-absorbing and slow- clinical experience grows, the use of these materials appears
absorbing fibers has also been explored (TIGR Matrix poised to usher in a new generation of regenerative surgery.
®
surgical mesh, Novus Scientific.) At an average follow-up
of 16 months, a favorable complication rate was observed Financial support and sponsorship
in a case series of breast reconstruction, revision implant Nil.
surgery, and primary aesthetic procedures.
[44]
Conflicts of interest
Because third generation meshes facilitate subcutaneous There are no conflicts of interest.
placement, mastopexy may be performed without
parenchymal disruption or reliance on a tight skin envelope.
For all internal bra materials, the ability to offload the weight REFERENCES
of the breast during the transition from graft to host is 1. Grewal NS, Fisher J. Why do patients seek revisionary breast surgery?
critical. Quickly-resorbing materials lose support before host Aesthet Surg J 2013;33:237-44.
tissue can develop, so the ability of the material to induce or 2. Forster NA, Künzi W, Giovanoli P. The reoperation cascade after breast
support ingrowth or replacement by host issue is an important augmentation with implants: what the patient needs to know. J Plast Reconstr
Aesthet Surg 2013;66:313-22.
variable. In practice, it is important to take advantage of the 3. Wessels L, Murphy S, Merten S. The capsular hammock flap for correction of
internal bra concept by adapting the skin envelope of the breast implant ptosis. Aesthetic Plast Surg 2014;38:354-7.
breast to the shape created by the material and close incisions 4. Bogdanov-Berezovsky A, Silberstein E, Shoham Y, Krieger Y. Capsular flap:
under minimal tension. This may minimize the potential for 5. new applications. Aesthetic Plast Surg 2013;37:395-7.
Johnson GW. Central core reduction mammoplasties and Marlex suspension
would breakdown and exposure of the material. Minimal of breast tissue. Aesthetic Plast Surg 1981;5:77-84.
tension closure may reduce the potential for hypertrophic 6. de Bruijn HP, Johannes S. Mastopexy with 3D preshaped mesh for long-
scarring as well. The ability to shape the breast mound as a term results: development of the internal bra system. Aesthetic Plast Surg
2008;32:757-65.
composite unit of implant and parenchyma by wrapping in a 7. Góes JC. Periareolar mastopexy: double skin technique with mesh support.
subcutaneous internal bra may prevent long-term problems of Aesthet Surg J 2003;23:129-35.
differential implant or breast ptosis. 8. Dieterich M, Stubert J, Gerber B, Reimer T, Richter DU. Biocompatibility, cell
growth and clinical relevance of synthetic meshes and biological matrixes
for internal support in implant-based breast reconstruction. Arch Gynecol
DISCUSSION Obstet 2015;291:1371-9.
9. Dixon JM, Arnott I, Schaverien M.J Chronic abscess formation following
mesh mastopexy: case report. Plast Reconstr Aesthet Surg 2010;63:1220-2.
By restoring support due to attenuated or weak tissues, 10. Duncan DI. Correction of implant rippling using allograft dermis. Aesthet Surg
revision surgery for combination problems may find a unifying J 2001;21:81-4.
solution with the internal bra. Despite the paucity of robust 11. Baxter RA. Intracapsular allogenic dermal grafts for breast implant-related
problems. Plast Reconstr Surg 2003;112:1692-6.
long-term data for newer materials, they are finding a role in 12. Baxter RA. Long-term follow-up with AlloDerm in breast reconstruction.
clinical practice. Each has its own limitations and advantages Plast Reconstr Surg Glob Open 2013;1:1-2.
[Table 3]. Although there are general characteristics that are 13. Baxter RA. Acellular dermal matrices in breast implant surgery: defining the
desirable across the category, different applications require problem and proof of concept. Clin Plast Surg 2012;39:103-12.
specific mesh attributes. In revision surgery, elasticity and 14. Boone MA, Draye JP, Verween G, Aiti A, Pirnay JP, Verbeken G, De Vos D,
Rose T, Jennes S, Jemec GB, Del Marmol V. Recellularizing of human acellular
expandability may be disadvantages while they are plusses dermal matrices imaged by high-definition optical coherence tomography.
for tissue expansion. Placement in the subcutaneous layer Exp Dermatol 2015;24:349-54.
is necessary for mastopexy, but placement too superficially 15. Spear SL, Sher SR, Al-Attar A, Pittman T. Applications of acellular dermal
matrix in revision breast reconstruction surgery. Plast Reconstr Surg
may result in unacceptable palpability or risk of exposure, 2014;133:1-10.
while in a deeper layer, non-take may be a concern because 16. Pozner JN, White JB, Newman MI. Use of porcine acellular dermal matrix in
revisionary cosmetic breast augmentation. Aesthet Surg J 2013;33:681-90.
of less vascularity. The consequences of non-take for second 17. Maxwell GP, Gabriel A. Efficacy of acellular dermal matrices in revisionary
and third generation materials include exposure, infection, aesthetic breast surgery: a 6-year experience. Aesthet Surg J 2013;33:389-99.
and possible need for removal of both the material and 18. Cayci C, Santner F, Jacobson SR. Impact and outcome of human acellular
implant. As application-specific characteristics such as pore dermal matrix size for immediate and two-stage breast reconstruction. Plast
Reconstr Surg 2013;132:11-8.
size, fiber size, monofilament vs. multifilament, degradation 19. Salzberg CA. Focus on technique: one-stage implant-based breast
profiles, and textile engineering become better understood, reconstruction. Plast Reconstr Surg 2012;130:S95-103.
these materials will be better optimized. The introduction 20. Topol BM. The use of human acellular dermal matrices in irradiated breast
reconstruction. Clin Plast Surg 2012;39:149-58.
of fixation devices and 3-dimensionally shaped constructs 21. Salzberg CA, Ashikari AY, Koch RM, Chabner-Thompson E. An 8-year
may broaden the appeal of the internal bra. experience of direct-to-implant immediate breast reconstruction using
6 Plast Aesthet Res || Vol 3 || Issue 1 || Jan 15, 2016