I love breast reductions and do tons of them.
A friend who lives on the East Coast had a breast reduction, and she shared that she had mesh placed. All I could think of is why? Why would you use mesh? And how? And cost? And why???
At my last national plastic surgery meeting I went to the talks about the new mesh Galaflex (made by Galatea) the newest darling in breast surgery , and I learned how it is used in breast lifts, breast reductions, and breast augmentations.
My basic takeaways?
- I DON’T NEED MESH FOR MY KIND OF BREAST LIFT AND REDUCTION. When you see mesh being used, it is almost always for the anchor style breast reduction and lift, NOT FOR THE VERTICAL BREAST LIFT. When you do an anchor reduction, you are leaving the lower breast tissue in place. The tissue you remove is the upper tissue. When you do this, you are leaving a lot of strain on the lower pole tissue. And if that tissue stretches the skin, which it invariably does, then the upper part of the breast- your cleavage area- falls. So they are using mesh to support the lower tissue.
- THE NEW MESH TYPES DON’T STRETCH AS MUCH. One of the issues with the ADM acellular dermal matrix which is widely used is that it loses its strength over time because it stretches, so when you placed it you need to overtighten it, anticipating the stretch over time. The newer mesh does not stretch. The one I did the CME training on was Galaflex. They stressed what you see on the operating room table is what you are going to get. You must sit the patient up when placing it, so you can see exactly how it sits, because it won’t change.
- THE GALAFLEX IS CHEAPER THAN ADM. One of the other issues with using “reinforcements” was simply the added cost. ADM adds thousands of dollars of cost. The newer mesh is much less expensive, though it still adds around $1600-2000 to the cost of the surgery simply for the mesh itself.
My thoughts?
I do a vertical breast reduction and lift, where I remove the lower tissue and move it up. The surgeons who use the mesh specifically DO NOT USE MY VERTICAL BREAST REDUCTION TECHNIQUE, and stated, “If you do a vertical breast lift, you don’t need to use mesh as you remove that lower tissue.”
My thought is why do the inferior pedicle anchor scar breast reduction? If you have to add mesh to keep your reduction from failing, why do the bigger scar, poorer shaping technique in the first place? I am not saying the vertical lift is perfect. I do have patients who stretch out. But the shape and lift is superior to the anchor breast reduction.
Mesh has issues: it adds another level of something that can go wrong, it adds cost, it can be palpable/you can feel edges sometimes, it can wrinkle, it can get infected, it can be unforgiving, and it could not be integrated into the tissue.
So will I use it?
Maybe. But likely only for those who have terrible tissue quality (like major weight loss patients) or those who had an anchor lift already- so I have to redo that same technique.
I did use Galaflex for a breast lift/implant patient who had terrible skin quality from weight loss to prevent it stretching over time. I will know how well it works years from now. I was able to use it with my vertical technique. So far so good.
SO….It’s another tool in my toolbox of breast surgery. I like to have options. I think it will be more useful in breast augmentation patients for those rare breast implant patients who I would have used a textured implant in during the past, as textured implants are no longer available due to ALCL.