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

Abstract

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