Polydioxanone Monofilament Mesh: A Safety Net for Complex Breast Implant Revision Surgery.

Abstract

<h4>Background</h4>Breast revision surgeries are complex cases requiring greater pocket control than primary surgeries. Intraoperative techniques to maximize pocket integrity are crucial to achieving an aesthetic result in revisions with implants.<h4>Objectives</h4>Uniform utilization of a polydioxanone (PDO) internal support matrix in a high volume of revision-augmentation cases has, to our knowledge, never before been described.<h4>Methods</h4>A high-volume (n = 104) single-surgeon experience followed patient outcomes in consecutive cases from September 2020 to March 2022. Included in this cohort were patients undergoing revision-augmentations with vertical or wise-pattern mastopexies (n = 74), revision-augmentation without mastopexies (n = 25), and revision without implant exchange (n = 5). Each case employed at least 1 sheet of PDO mesh, with a small set (n = 4) receiving 2 sheets. Patients were followed up (range, 3-19 months), with 3 months minimum follow-up to assess outcomes.<h4>Results</h4>The average length of follow-up was 8.8 months. Patients in this cohort had undergone an average of 1.6 prior breast surgeries (range, 1-7). A total 89.4% of patients received an increase in implant volume (average change, +165.2 Cc); 87.5% of patients had favourable aesthetic outcomes, and 12.5% of patients were reoperated on (including reoperations for complications and/or aesthetic reasons). There were 13 complications in the cohort, and no mesh-related complications.<h4>Conclusions</h4>PDO mesh is a safe and effective method of increasing pocket control in breast revision. Supplemental soft-tissue support allowed greater implant volumes to be employed, yielding high rates of patient satisfaction with breast shape, scarring, and long-term aesthetics.<h4>Level of evidence: 4</h4>