Polydioxanone Monofilament Mesh: A Safety Net for Complex Breast Implant Revision Surgery
Breast revision surgeries, especially in patients who have undergone multiple previous breast implant surgeries, are complex cases requiring greater pocket control than primary surgeries. Intraoperative techniques to maximize pocket integrity are crucial to achieving an aesthetic result in patients undergoing breast revisions with implants. Uniform use of a Polydioxanone (PDO) internal support matrix in a high volume of revision-augmentation cases to improve pocket control, decrease scar burden when a concurrent mastopexy is performed, and prevent malposition has never before been described.
Methods/Technique:
A high volume (n=104) single surgeon breast revision experience (SSK) followed patient outcomes in consecutive cases from September 2020 to March 2022. Included in this cohort were patients undergoing revision augmentations with a vertical or wise-pattern mastopexy (n=74), revision-augmentation without a mastopexy (n=25), and breast revision without implant exchange (n=5). Each surgical case used at least one sheet of PDO mesh, with a small set of patients (n=4) receiving two sheets of mesh. The majority of patients were followed for at least six months post-surgery. A minimum of 3 months followup was used to assess patient outcomes.
Results/Complications:
The average length of followup was 6.9 months. Patients in this cohort had undergone an average of 1.6 prior breast surgeries (range 1-7). 89.4% of patients received an increase in implant volume, with an average change of +165.2 cc’s in the cohort. 87.5% of patients had a favorable aesthetic outcome with no need for reoperation. 12.5% of patients were reoperated on (including reoperations for complications or aesthetic reasons). There were 13 complications in the cohort, and zero mesh-related complications.
Conclusion:
Using PDO mesh is a safe and effective method of increasing pocket control in breast revision surgeries by providing additional soft tissue support. This allowed for greater implant volumes to be used and high rates of patient satisfaction with their breast shape, scarring, and long-term aesthetics.