Inferior Capsulorrhaphy Using GalaFLEX
Throughout his experience using GalaFLEX mesh, Dr. Bruce Van Natta of Indianapolis, IN has found a couple of different ways to use the mesh in capsulorrhaphy. Typically, now, when he does a capsulorrhaphy, he will do a suture capsulorrhaphy in which he uses a row of interrupted 2-0 ethibonds followed by a running locked 2-0 ethibond suture. In this case, though, he is actually going to use the mesh, anchoring it exactly on that point on the chest wall where he wants the inframammary fold. You could still go ahead and do a few simple sutures to close down that gutter of the capsule. There is no problem with doing that especially if you want a little extra reinforcement.
But in this video, he is just using a strip of the mesh. Keep in mind that this mesh isn’t going to stretch or give so you have to make sure that you have enough fullness in the mesh to allow the implant to sit where you want it. In fact, if there is any question, he always recommends that you sit the patient up to check. For this, he is just going along and tacking in multiple places. The sutures that he is placing go all the way down to the chest wall. He wants a really substantial bite so that he knows that he is truly creating the inframammary fold. This mesh is really powerful for this. If you have a little bit of fold malposition, there is an opportunity to correct this with the mesh as well. He’s had good luck with this. But most commonly, as seen in this video, he will just do a traditional suture capsulorrhaphy and take a similar size strip of mesh, and tack it down in 3 or 4 locations. Now, this video shows the plain, flat mesh but there is now the rimmed variety, GalaFORM, which offers another option for us in terms of how to use it because with the rim, it’s really going to hold the position.
You can use one long piece of mesh like this to support not only inferiorly, which is his primary issue with this case, but if you want, you can go on and tack down laterally to reinforce. You can see in the video how the mesh provides almost a parachute effect after it is tacked down. Then, he places the implant. There is a rougher and smoother side to the mesh. Dr. Van Natta always places the smoother side towards the implant. He then tacks the superior edge. While the mesh is stiff enough that it tends to hold position, you don’t want it folding or falling down. The key here is that you don’t want to suture this superior edge to the pectorals because then you would lose your dual plane effect. You could do this with simples, but in this case, he’s doing it as a running just to make things move along a little quicker. Once finished, you can see how nicely the implant is covered and even though it is a 2-D piece of mesh, you can see that it is doing a nice job of shaping. Then, close with whatever standard closure you use. With the mesh, Dr. Van Natta is able to achieve a really lovely outcome while also minimizing any future chance of pocket stretch. It allows him to use a little bit bigger implant, as in this case, and not have to worry.