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

Abstract

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.

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

“…Synthetic absorbable meshes in particular have garnered attention for utilization in aesthetic breast surgeries, because their absorption profile allows for the most support during the initial months of soft-tissue healing while being thin/non-palpable, non-permanent, and relatively economical. 6 , 11 Recent studies conducted with P4HB matrices in cosmetic breast revisions support the safety and aesthetic benefit of resorbable matrices in conjunction with implants yet call for further investigation. 12 DuraSorb PDO mesh was chosen for utilization in aesthetic revision bases due to its shorter absorption profile of 3 to 12 months combined with its unique level of strength as a thin, non-palpable produce.…”

“…The implantation of the mesh was conducted as previously described by the authors; while preparing the breast pocket, the monofilament mesh was removed from its sterile packaging and soaked in a triple antibiotic irrigation solution consisting of 50,000 units of bacitracin, 1 g cefazolin, 80 mg gentamicin in 1 L of normal saline or a 50% povidone-iodine solution. 6 After dissection, the 10- × 25-cm mesh was routinely removed from the solution and cut in half. Each half was oriented such that the smooth surface would be facing toward the patient's breast implants and the rough surface toward the breast tissue.…”

“…Scar quality in patients who received a mastopexy was evaluated by photography and then scored by an independent observer according to a previously described 5-point scar scale, where 1 corresponds to a hypertrophic/keloid scar and 5 denotes a thin, well-toned scar that blends with the native breast tissue ( Figure 2 ). 6 …”

“… Mastopexy scar scale. Reproduced from Chiemi JA and Kelishadi SS 6 by permission of Oxford University Press on behalf of The Aesthetic Society. …”

“…4 The authors have recently shown significant benefits in pocket control and a decrease in scar malposition rates with PDO mesh in primary breast augmentation cases as well as improved scar aesthetics with PDO mesh reinforcement in primary mastopexy-augmentations. 5 , 6 It is hypothesized that the benefits of PDO mesh reinforcement could be further applied to more challenging and complex aesthetic breast surgeries.…”