Polydioxanone Internal Support Matrix: A Rationale for Prophylactic Internal Bra Support in Breast Augmentation

Internal Bra: A literature Review and Sub-Classification of Definitions

BACKGROUND

The term 'internal bra' refers to a range of techniques that aim to stabilise the position of the breast and improve longevity of surgical results. It is increasingly being used to describe techniques in surgical literature and on patient information platforms, including social media. However a lack of consistency in the use of the term is a potential source of confusion and conflicting information.

OBJECTIVES

This narrative review aims to improve understanding of what is meant by the term 'internal bra', by providing an overview of the different techniques it refers to and suggesting more specific terminology for use going forward.

METHODS

A literature search of the Medline, Embase, and Google Scholar databases was conducted to identify papers in which a surgical technique was described using the term 'internal bra'.

RESULTS

'Internal bra' techniques can be categorised into 5 groups: mesh techniques, acellular dermal matrix techniques, suture techniques, dermal flap techniques, and muscle techniques. Promising results exist for techniques in each group; however, research is generally limited by small studies with short follow up periods, and significant inconsistencies exist in use of the term 'internal bra'.

CONCLUSIONS

The titles of the five groups identified in this paper should be used going forward when discussing 'internal bra' techniques, in order to bring greater clarity to both surgical literature and patient information. Further research is also required to establish if 'internal bra' techniques truly improve longevity of surgical results and if one technique, or group of techniques, is superior.

NO LEVEL ASSIGNED

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Polydioxanone Monofilament Mesh: A Safety Net for Complex Breast Implant Revision Surgery

BACKGROUND

Breast revision 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 revisions with implants.

OBJECTIVES

Uniform utilization of a polydioxanone (PDO) internal support matrix in a high volume of revision-augmentation cases has, to our knowledge, never before been described.

METHODS

A high-volume (n = 104) single-surgeon experience followed patient outcomes in consecutive cases from September 2020 to March 2022. Included in this cohort were patients undergoing revision-augmentations with vertical or wise-pattern mastopexies (n = 74), revision-augmentation without mastopexies (n = 25), and revision without implant exchange (n = 5). Each case employed at least 1 sheet of PDO mesh, with a small set (n = 4) receiving 2 sheets. Patients were followed up (range, 3-19 months), with 3 months minimum follow-up to assess outcomes.

RESULTS

The average length of follow-up was 8.8 months. Patients in this cohort had undergone an average of 1.6 prior breast surgeries (range, 1-7). A total 89.4% of patients received an increase in implant volume (average change, +165.2 Cc); 87.5% of patients had favourable aesthetic outcomes, and 12.5% of patients were reoperated on (including reoperations for complications and/or aesthetic reasons). There were 13 complications in the cohort, and no mesh-related complications.

CONCLUSIONS

PDO mesh is a safe and effective method of increasing pocket control in breast revision. Supplemental soft-tissue support allowed greater implant volumes to be employed, yielding high rates of patient satisfaction with breast shape, scarring, and long-term aesthetics.

LEVEL OF EVIDENCE: 4

"Never Trust the Skin": A Rationale for Using Polydioxanone Internal Support Matrix to Minimize Scarring in Primary Mastopexy-Augmentation-An Observational Study

Background

The process of scar formation is complex and multi-factorial. Basic plastic surgery tenets focus on tension-free techniques to optimize aesthetic outcomes and minimize scarring.

Objectives

Prophylactic use of a polydioxanone (PDO) internal support matrix in cosmetic mastopexy-augmentation to decrease scar burden has never before been described.

Methods

A high volume (n = 41) single-surgeon mastopexy-augmentation experience (S.S.K.) followed scar quality in consecutive cases from June 2020 to July 2021. A minimum of 6 months of postoperative evaluation was required to assess scar quality. Fitzpatrick scores were also evaluated and compared. All surgeries in this study were performed in the dual plane using silicone gel implants, a superior or superomedial dermal pedicle blood supply, and a wise-pattern or vertical scar. Scar quality was evaluated by photography and scored according to an internally developed scar quality scale.

Results

There have been no cases of hypertrophic or keloid scarring. All patients receiving mastopexy-augmentation with prophylactic PDO mesh have a favorable appearance with fine line scars, and the mean scar quality scale score across the cohort was 4.341/5. The mean Fitzpatrick scale score across the cohort was 2.97, and, of the patients who scored a 5 on the scar quality index, the mean Fitzpatrick scale score was 3.545.

Conclusions

Prophylactic use of PDO internal support matrix in silicone gel mastopexy-augmentation offers further protection against poor scarring in patients across the Fitzpatrick scale, with varying degrees of skin quality, and across medium to high-volume implant augmentations. Patients who received PDO prophylaxis demonstrated a better-than-average scar appearance.

Level of Evidence 4