Any aesthetic surgical procedure must not only deliver the exemplary result that the patient desires. It must also be one that stands the test of time. Unfortunately, when it comes to breast implants, these two things may be at odds. As one of the country’s leading breast surgeons, Dr. Bruce Van Natta has a lot of experience with a patient coming into his office wanting an implant that her body can’t really support. Placing a too large implant in a small framed patient or in breast tissue that is weak can lead to trouble. With time, the implant may shift either medially, laterally or vertically. Some of the more common types of implant malposition include:

  • bottoming out: implant slips below the inframammary fold or crease beneath the breast
  • Symmastia: one or both implants shift towards the middle of the chest
  • asymmetry: implants become uneven
  • lateral shifting: one or both implants move out towards the armpit

The great thing about soft tissue support is that it can act like an insurance policy against future implant malposition.

Soft Tissue Support Can Help Prevent Implant Malposition

Dr. Van Natta is passionate about looking for new solutions to old breast surgery problems such as fold malposition. The goal of this website is to share his knowledge with both patients and fellow surgeons. He began using soft tissue support in the form of absorbable scaffolds as a way to provide an internal bra of support for his breast surgery patients. While he’s tried the full range of absorbable scaffolds over the years, including SERI and ADMs, he now exclusively uses the Galatea Scaffolds collection. He finds that this P4HB product provides:

  • the most tensile strength initially and over time
  • easily reabsorbed as it’s a naturally occurring biopolymer in the body
  • delivers lowest rate of infection (Dr. Van Natta’s is zero)
  • long laster results as it does not stretch

When used in a primary breast augmentation or in revision breast surgery, soft tissue support provides an internal scaffold that makes the breast tissue stronger by inducing the patient’s own body to produce more collagen in response to the “injury” of the mesh.  This collagen weaves in and out of the mesh, which eventually dissolves, leaving the patient with her own internal bra. As you can see in this video, the extra support allows you to place an implant in less than ideal breast tissue and/or safely use a larger implant than you would have been able to use in the past without worrying that the implant will eventually bottom out.

Soft Tissue Support and Capsulorrhaphy

In this video, breast surgery expert Dr. Jason Pozner walks us through his version of a capsulorrhaphy with soft tissue support. The patient presents with a problem that he sees all the time. She has bottomed out. After going through menopause and gaining some weight, the tissues of the breast became weak and the implants dropped below the inframammary fold. She wants her high, tight breasts back. He performs a capsulorrhaphy to remove part of the capsule. Then, in this case where there is a good, big capsule, he uses a running quill stitch to shape the capsule, and then places the GalaFLEX mesh for added support. In other cases, he may rely more on the mesh itself to provide the shape. Using a medium sized piece of GalaFLEX, he stitches the mesh into place. He doesn’t like for there to be folds or wrinkles in the mesh as it can make the result a little too firm.

You also don’t want the mesh to be too tight. In the video below, you can see how Dr. Van Natta uses the mesh to create an inframammary fold. It is important to keep in mind that the mesh itself does not stretch so his advice is that if you are at all unsure about your placement, sit the patient up to double check. While he uses the plain, flat GalaFLEX mesh here, there is now the rimmed GalaFORM which offers yet another option for creating a very nice shape that really holds position.