Breast implants can have issues over time- implant migration, breasts drooping with age, your desire for a different size. So when you do a breast implant revision what do you choose to do? This study looks at women who chose to move their implants from behind the muscle to in front of the muscle. Why? It allows more lift generally, you won’t get a movement of your breast when you move your muscle so called “animation deformity”, and it allows a new pocket which helps if implants have migrated or if you want to do a smaller size and control the new pocket.
Why don’t we just put all implants in front of the muscle? There are studies which show increased capsular contracture rates and more difficult mammograms. But one of the biggest reasons is coverage. The “soft tissue” (ie your breast tissue and fat) in your cleavage area tends to be thin. You don’t want to see implant edges or wrinkling in the area shown by V neck or strapless clothing. So putting the implant under the muscle adds another thicker layer to your cleavage so you won’t see the implant. Ideally you need at least 2 cm of coverage in this area.
But if you want to go in front of the muscle, what can you do?
This was out of the Aesthetic Surgery Journal 2023. “Synthetic Reabsorbable Mesh (GalaFLEX) as Soft Tissue Adjunct in Breast Augmentation Revision Surgery.”
This was a series of 34 patients who changed from a subpectoral to subglandular pocket. They used a large piece of Galaflex in a triangular shape placed through the augmentation incision to mimic coverage of the pectoral muscle in the upper pole cleavage area. They did not have issues with wrinkling, rippling, capsular contracture. They always used high profile highly cohesive textured form stable silicone gel implants.
Galaflex is a synthetic reabsorbable mesh, based on poly4 hydroxybutyrate. Complete resorption of the matrix with connective tissue takes 6 – 12 months after placement. This new connective tissue is 0.75 to 1.5mm in thickness.
They do state, “We do not believe that improvement in tissue thickness with GalaFLEX has a significant effect on the aesthetic outcome but rather contributes to prevention of postoperative complications.”
My thoughts?
I use GalaFLEX at times, mostly in my super thin patients to support the lower pole. It is cheaper than ADM and many of my colleagues feel it gives better support and stays more effective with time.
In this study the mesh is trying to “thicken” the superior pole of the breast, but by the previous studies the mesh thickens by about 1 mm. That isn’t much thickness. Does it reduce capsular contracture rates? Does it make it harder to see rippling? Show me another benefit.
They also used highly cohesive high profile implants. These don’t tend to ripple and wrinkle. So is the lack of rippling and wrinkling due to the mesh or the implant type?
I am a fan of GalaFLEX. I am just not sure if the cost vs. benefit is warranted here. I need more information.