Breast cancer is a prevalent and potentially devastating disease that will affect 1 in 8 women during her lifetime as well as some men. Many of these patient are going to need a mastectomy to remove one or both breasts as part of their treatment protocol. Losing their breasts can have an adverse affect on a patient’s sense of self since, as one of the two main power centers on a woman’s body, they are an integral part of her physique, her femininity and sometimes even her personality. This is why breast reconstruction is so important. It can make a woman feel whole again.
Breast Reconstruction Options
There are a number of different options these days when it comes to breast reconstruction. These include:
- autologous reconstruction
- direct to implant reconstruction
- tissue expander reconstruction
- revision reconstruction
As the name implies, autologous reconstruction uses the patient’s own tissue to reconstruct the breast. Typically taken from the abdomen in what is called a DIEP or TRAM flap, tissue can also be harvested from the back (Latissimus dorsi flap), buttocks (GAP flap) and inner thigh (TUG flap). In a direct to implant or tissue expander reconstruction, a breast implant is used to create the new breast. In all of these procedures, including revision reconstruction to fix an initial surgery with less than ideal results, soft tissue support is turning out to be a huge benefit.
Soft Tissue Support with Breast Reconstruction
Breast surgery expert Dr. Bruce Van Natta began his career doing breast reconstruction. Though he has now moved primarily into the aesthetic arena, he is still passionate about the potential aid that soft tissue support can provide in breast reconstruction procedures. Just as in primary breast augmentation, maxtopexy, maxtopexy augmentation and breast reduction procedures, a scaffold will create an internal bra of support for either the implant or the patient’s own tissue in breast reconstruction procedures.
An early adopter of soft tissue support as a means of delivering better, longer lasting results for his patients, Dr. Van Natta has used a wide variety over the years including:
- ADM – dermal matrix such as Allerderm & Stratis
- TIGR – combination of multifilament PGLATMC/PLATMC
- SERI – multifilament silk
- Vicryl – multifilament PLGA
- Galatea Scaffolds – poly-4-hydrozybuterate (P4HHB)
Benefits of P4HB
Though a fan of soft tissue support in general, Dr. Van Natta exclusively uses the Galatea Scaffolds collection these days due to the many benefits of P4HB. This mesh not only has an initial tensile strength that exceeds many of its competitors, but it retains 50-70% of this strength 4 months post operatively. It also:
- helps with wound healing for 52 months
- is easily reabsorbed by the body since it’s a naturally occurring biopolymer
- low rate of infection
- delivers long lasting results as it does not stretch
Soft tissue support works by promoting the patient’s own body to produce collagen in response to the “injury” of the mesh. This collagen forms around and between the mesh which eventually dissolves. The patient is then left with an internal bra, hammock or sling of support made of her own tissue that is both strong and durable. This helps ensure that the shape of her new breast will be long lasting.
Exciting Potential of Soft Tissue Support in Breast Reconstruction
In direct to implant reconstruction, nipple sparing mastectomies, and prepectoral reconstructions, soft tissue support can help to deliver:
- better positioning
- improve lower pole expansion
- increase projection
This can help you to deliver the ideal breast for your patient and/or match her existing breast. Many of Dr. Van Natta’s esteemed colleagues are using P4HB in direct to implant reconstructions to basically create a pec extension. He has also anecdotally heard that some breast surgeons are attempting to do the entire pre-pectoral implant wrap with GalaFLEX. In many ways, surgeons have only begun to scratch the surface in terms of potential uses of soft tissue support in breast reconstruction cases. It’s incredibly exciting and is one of the things that Dr. Van Natta admires most about this incredibly versatile product. Surgeons are really only limited by their own imagination.