The goal of any breast surgery is to deliver on your patient’s “dreams”. But you also want a result that will stand the test of time. Unfortunately, these two desires are often at odds with one another. 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 outcome that her body can’t really support. The problem with placing a too large implant in a small framed patient or in breast tissue that is weak is that it will commonly lead to implant or fold malposition down the road.
What is Implant Malposition?
Breast tissue is like anything else on the body. It breaks down with age, weight gain/loss and hormonal issues. This weakened tissue becomes loose and no longer has the durability to hold a patient’s breast implant in its proper place. The implant can shift either medially, laterally or vertically. Some of the more common types of implant malposition include:
- bottoming out – implant slips below 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
Soft Tissue Support Can Prevent Fold 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 almost 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 over time 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. The patient’s body will respond to the “injury” of the mesh by producing its own collagen which will weave in and out of the mesh. Over time, the mesh itself dissolves and the patient is left 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.
Soft Tissue Support and Capsulorrhaphy
Capsulorrhaphy is another area where soft tissue support can be very beneficial. Dr. Van Natta uses it to reduce the size of the capsule and correct fold malposition. This can be particularly helpful in an implant exchange. More and more women today are deciding to go smaller these days. Many received their first breast implant in their 20’s, but now that they are in their late 30’s or early 40’s, their aesthetic has changed. Soft tissue support is a fantastic aid in reducing the size of a pocket in an implant exchange when the patient is going from larger to smaller as it helps minimize the risk of pocket stretch down the road.
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.