Breast Augmentation Fold Malposition GalaFLEX Placement
Dr. Bruce Van Natta of Indianapolis, IN had been using GalaFLEX with mastopexy and breast reduction patients with much success so it occurred to him to try it in primary augmentations where there is minimal tissue and/or fold malposition. A lot of times, you will see an inframammary fold that is higher or lower on one side. In the first case where he tried this, shown in this video, he anchored the mesh in 2 or 3 positions using s/b: 2-0 PDS. But, he only placed the GalaFLEX on the fold that he wanted to lift. While that side didn’t move, unfortunately, the other side did stretch. So he recommends that if you are using mesh to try and move the fold up 1 or 1 1/2 centimeters that you also place a piece of mesh on the other side to maintain the position of the breast. It can be a little tricky because sometimes the mesh will twist a bit as it is being placed so the surgeon needs to double check. Also, the mesh has a side that is rougher and a side that is smoother side so he always tries to keep the smoother side inside.
In the video, you can see how he’s anchored the mesh at the inframammary fold and then after the implant is placed, he takes a couple of vicryls and tacks it to the parenchyma, not to the muscle, as you don’t want to lose your dual plane effect. The body will then incorporate this with collagen. He has had no cases of pocket stretch when he has used mesh in a primary augmentation and it allows him to place a slightly larger implant than he would normally use. With the advent of the GalaFORM in which there is a rim, the surgeon can put in a small rectangle that’s almost like a rectangular diaphragm which only needs to be anchored at the 6 o’clock position. This makes things a little easier, but if you don’t have the GalaFORM, you can still use the flat mesh, tacking down in 3 places along the fold and 2-3 places superiorly and then close as you normally would.
Dr. Van Natta has had patients out 2-3 years where he’s used this technique with bigger implants. The patient in this video shows a crescent maxtopexy for symmetry. The mesh allows him to put a big girl implant in these gals where in the past he would have had to be a little more conservative. It’s like an insurance policy for these patients to limit the chance of their having pocket stretch.