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 (SSK) followed scar quality in consecutive cases from June 2020 to July 2021. A minimum of 6 months post-operative 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 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 better-than-average scar appearance.

Background Textured breast implants have been used in aesthetic breast surgery to decrease rates of malposition and capsular contracture. Recent concerns regarding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)’s link to textured devices have prompted many physicians to re-evaluate their use. Objectives The authors aimed to create an algorithm for when to use smooth versus micro-textured breast implants and provide their rationale for when micro-textured implants may be more beneficial. Methods 133 patients received primary augmentations performed by a single surgeon from January 2018–December 2020. 84 patients received smooth implants and 49 patients received micro-textured implants. All surgeries were performed in the dual-plane using an inframammary incision. Implant-related complications and scar malposition were recorded and compared between groups. Results No significant difference in the prevalence of implant-related complications was found (3.57% for smooth devices and 2.04% for micro-textured devices [P-value 0.621257, 95% CI -0.06100–0.007467]). There were no cases of BIA-ALCL. Comparison of scar malposition rates between the smooth and micro-textured groups also revealed no statistically significant difference (15.4% for smooth devices and 8.16% for micro-textured devices [P-value 0.226156, 95% CI -0.1200–0.007467]). Patients in the micro-textured group proportionately had more anatomical risk factors for malposition. Conclusions Micro-textured breast implants continue to be a safe and effective choice for patients. Micro-textured implants show a trend towards decreased scar malposition, although not statistically significant. Patients at high risk for malposition with micro-textured breast implants give similar results to patients at average risk for malposition with smooth implants.

Background Textured breast implants have been used in aesthetic breast surgery to decrease rates of implant malposition. Recent analysis of a large-volume single-surgeon experience found statistically similar rates of malposition in smooth versus micro-textured breast implants. Objectives Prophylactic use of a Polydioxanone (PDO) internal support matrix in breast augmentation was hypothesized to prevent scar malposition and increase pocket control. Methods 200 patients received silicone gel primary augmentations performed by a single surgeon from January 2018–December 2020. 84 patients received smooth implants alone; 49 patients received micro-textured implants; 67 patients received smooth implants plus PDO internal support matrix. All surgeries were performed in the dual-plane using an inframammary incision. Implant-related complications and scar malposition were recorded and compared. Results No significant difference in implant-related complication rates was found between shell types (3.57% for smooth devices alone, 2.04% for textured devices [P=0.62, 95% CI -0.06–0.01]). There were zero complications in the smooth plus mesh study arm. Comparison of scar malposition rates between the smooth alone and textured groups revealed no significant difference (15.4% for smooth devices and 8.16% for textured devices [P=0.23, 95% CI -0.12–0.01]). The smooth implant group with prophylactic placement of PDO mesh had the lowest scar malposition rate of 4.48%, a significant difference compared to the smooth devices alone [P=0.03, 95% CI -0.21– -0.01%]. Conclusions Micro-textured devices show a trend towards decreased scar malposition, although not significant. Prophylactic use of PDO internal support matrix in silicone gel breast augmentation is safe and has the lowest incidence of scar malposition.

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 use of a polydioxanone (PDO) internal support matrix in a high volume of revision-augmentation cases has 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 used at least one sheet of PDO mesh, with a small set (n = 4) receiving two sheets. Patients were followed (range 3-19 months), with 3 months minimum follow-up used 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). 89.4% of patients received an increase in implant volume (average change +165.2 mLs). 87.5% of patients had favorable 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 zero 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 used, yielding high rates of patient satisfaction with breast shape, scarring, and long-term aesthetics