Improved Pocket Control in Primary Breast Augmentation with Smooth Silicone Breast Implants and Prophylactic Polydiaxonone Mesh
associated anaplastic large cell lymphoma (BIA-ALCL) and its link to textured breast devices have prompted many plastic surgeons to re-evaluate their use. Recent analysis of a large
volume single surgeon experience (SSK) found statistically similar incidences of malposition in smooth versus micro-textured breast implants. Prophylactic use of a Polydioxanone (PDO) internal support matrix in cosmetic breast augmentation to prevent malposition has never before been described.
Methods/Technique: 200 patients received primary breast augmentations performed by a single surgeon (SSK) from January 2018 to December 2020. 84 patients received smooth
silicone gel breast implants alone; 49 patients received micro-textured silicone gel breast augmentation; 67 patients received smooth silicone gel breast implant plus PDO
internal support matrix. All surgeries were performed in the dual-plane using an inframammary incision in conjunction with the 14-Point Plan. Overall breast implant surgery related complications and inframammary (IMF) scar malposition (>2mm scar migration) were recorded and compared between device surface and manufacturer groups. IMF scar malposition was used as a marker of inferior breast implant malposition.
Results/Complications: No significant difference in the prevalence of post-operative breast implant surgery related complications were found between implant shell types with a complication rate of 3.6% for smooth alone devices and 2.04% for textured. There were zero surgical complications in the smooth plus PDO internal support matrix study arm with a minimum follow-up of 2 months. There were no cases of breast-implant associated anaplastic large cell lymphoma in all three groups. Comparison of the IMF scar malposition rates between the smooth and textured implant groups also revealed no statistically significant difference (15.5% for smooth devices and 10.2% for textured devices). The patients in the textured group proportionately had more anatomical risk factors for malposition. The smooth silicone gel breast augmentation group with prophylactic placement of PDO internal support matrix had 4.5% cases of implant malposition. Smooth silicone gel breast implant augmentation in conjunction with prophylactic PDO internal support matrix suggests a statistically significant advantage (p<0.05) over smooth breast implants used alone in preventing inferior malposition of silicone breast prostheses.
Conclusion: In silicone gel breast augmentation, micro-textured devices by themselves show a trend towards decreased malposition, although not statistically significant. Patients at high risk for malposition with textured breast implants give similar results to patients at average risk for malposition with smooth implants. Prophylactic use of PDO internal support matrix in silicone gel breast augmentation is safe and offers further protection against inferior breast implant malposition.