Use of GalaFLEX Mesh in Primary Breast Augmentation
Due to my success using the GalaFLEX mesh in mastopexy and reduction patients, I have found it to be such a powerful force in being able to control the inframammary fold that I now use it in my primary breast augmentation patients, particularly in cases of very small busted gals. With the A minus minus kind of cases, I began to recommend the mesh, and I have had nothing but good outcomes so far.
After you’ve done your pocket dissection subpectoral, you mark the points medially and laterally. The keystone is right here at the 6 o’clock position. As you can see in the video, I am really getting good purchase going all the way down to periosteum. With the mesh, there is a rougher and a smoother side so I always put the smoother side towards the implant. I am not sure that it makes one bit of difference since this is incorporated into collagen so quickly. After I get that 6 o’clock position, I tuck the mesh in so that it’s not touching the skin. This is really the key suture because where you place that is really going to limit the lower excursion of the imframammary fold. This gets a little tricky through such a small incision. You’ve got to really get in there and get this suture anchored for the lateral. You can get a little folding and wrinkling. I admit that it can be a little frustrating using this small piece of mesh that will sometimes turn so you need to just keep checking and make sure that you are happy. Now, the GalaFORM products that have come out have a rim, and there is a rectangle piece with the rim around it that you can tack down at the 6 o’clock position and that’s probably the only anchoring that you’ll need.
As you can see with this patient, the mesh enables me to use a little bigger implant than I would typically be comfortable using because she has such minimal tissue covering and stretchy skin. I view the mesh in these cases as an insurance policy. I always remind my patients that if they end up with pocket stretch, it will cost a lot more to do a revision than to use the mesh.
At this point, I tack the mesh to the periosteum, not to the muscle. This is really key because if you were to tack that mesh to the lower edge of the pectorals, you’ve just eliminated any dual plane effect. It may not be as important in some of these really small busted gals, but as a general rule, you want to just be tacking this edge so it doesn’t roll down. You’re creating a rim or shelf of support once that collagen incorporates which we know it does quickly. In a matter of just a few weeks, we have incorporation of up to a millimeter of thickness. Tacking this, I will usually do at least a couple of points of fixation and then reach in with my finger to make sure that the mesh is in the position that I want. Then, you can see that the mesh really covers the lower portion of the implant nicely. Then after closure, you can see how the mesh really stops the downward progression of the implant. I have had no cases of pocket stretch in any of the 30-40 cases that I have done so far. Some of them followed out 2-3 years.