Breast reduction is one of those procedures that can literally change a woman’s life. Besides vastly improving the look of her entire torso by creating breasts that are proportional, a breast reduction can also have a profound impact on the patient’s self esteem, making her feel more confident and comfortable in her own skin. Traditionally, a breast reduction procedure, after the excess volume has been removed, relies entirely on tightening the skin envelope to maintain the new breast shape over time. The problem with big breasts, however, is that the skin and tissues are often compromised from years of the excess breast weight pulling down and stretching them.
Breast surgery expert, Dr. Bruce Van Natta, has spent the majority of his 30 year career searching for new solutions to his patients’ problems. An early adopter of soft tissue support, he has found it to be what he calls an “insurance policy” when it comes to his breast reduction and mastopexy or breast lift patients. The scaffold creates an internal bra of support that helps ensure that a patient’s new breasts will stand the test of time.
Soft Tissue Support Reduces Potential Need for Revision Surgery
The goal of any breast procedure is to create beautiful breasts that deliver on a patient’s dreams. But you also want these results to last. This can often be a problem when the skin and tissues of the breasts are weak and sag due to:
- age
- weight gain/loss
- pregnancy
- breastfeeding
- menopause
- hormonal shifts
The compromised skin has a tendency to re-stretch particularly if there is an implant involved such as in a maxtopexy augmentation. Soft tissue support helps to reduce the risk of changes down the road that may require revision breast surgery by creating an internal bra, sling or hammock of a patient’s own tissue.
Wide Range of Soft Tissue Support
Over the years, Dr. Van Natta has tried many different absorbable scaffolds or soft tissue support such as:
- SERI – multifilament silk
- TIGR – combination of multifilament PGLATMC/PLATMC
- Vicryl – multifilament PLGA
- ADM – dermal matrix such as Allerderm & Stratis
- Galatea Scaffolds – poly-4-hydrozybuterate (P4HB)
His goal is to share his knowledge with patients and fellow surgeons. A huge fan of soft tissue support in general, Dr. Van Natta now exclusively uses the Galatea Scaffolds collection due to the many benefits of P4HB. A naturally occurring biopolymer in the body, P4HB has a low infection rate, does not stretch, and is easily reabsorbed over time. All of the mesh scaffolds work by inducing the patient’s own body to produce collagen which quickly weaves in and out of the mesh. Eventually, the scaffold dissolves, leaving behind a durable, strong, natural collagen scaffold of support.
Soft Tissue Support in Breast Reduction with Wise Pattern
In all of his breast reduction and breast lift procedures and most of his maxtopexy augmentation procedures, Dr. Van Natta uses the wise pattern with the GalaFORM mesh in a medium. As you can see in this video, this scaffold has a 3-D shape with a rim which he helped to design. He loves the product, but he did find, in his first few cases, that when he closed, the upper rim would buckle a bit. His solution is to cut off the top rim. He calls it the “Topless GalaFORM”.
It’s important to really anchor the mesh in order to create the inframammary fold. With the flaps on the Galatea Scaffolds collection, you need to elevate them enough to lay in that 3-D shape, and then secure the medial and lateral tabs. Occasionally, if Dr. Van Natta has a situation where he is worried about blood supply, he will simply cut off the medial and lateral portions, leaving just the center section. This is also his typical MO when doing a vertical maxtopexy or reduction. So far, he’s had great success. The material is pretty flexible so don’t be afraid to modify the design in order to fit the needs of your individual patient. While there are many different options, the goal is always to create an internal bra, hammock or sling of support in order to guarantee a long lasting result.