Soft tissue support has come a long way in the years since Dr. Bruce Van Natta of Indianapolis, IN started his practice. The focus of this site is on a really interesting material called P4HB (Poly-4-hydroxybutyrate). It’s a polymer that was initially developed as a suture, but if you can make a suture, you can weave it into mesh. Bard licensed the same material that he’s discussing on this site as Phasix which is used in abdominal wall repair/hernia repair. They had such great success that it led the company who was developing the polymer to think about other applications in other areas. The first being the face. ??? has done some work there supporting the SMAS and brow lifting. Next, Dr. Bill Adams was called on to evaluate the product for use in breast surgeries. He had some really impressive initial results so the company decided to initiate a clinical trial. Dr. Van Natta was fortunate enough to be one of the early investigators and this website is really about him sharing where they’ve gone with the product as well as how the product has evolved.
The initial product, GalaFLEX, was just a flat piece of mesh. What Dr. Van Natta would typically do is fold the mesh, cut it and then, say in a mastopexy or reduction, suture that mesh in. One of the frustrations, however, with this initial product is that it is a 2-D flat shape that he was trying, in the case of a breast, to shape or form around a spherical object. So, he worked with the company a bit and found that this polymer can be heated and shaped which led to the idea of creating a more 3 dimensional, cup shaped piece of mesh called GalaSHAPE. This Generation 2.0 version even has some tabs for anchoring. Then, with the 3.0 version called GalaFORM, they added a rim made out of the same polymer. This helps to hold the shape even more. It comes in various shapes as well as different sizes.
With these products, Dr. Van Natta has now gone beyond his initial work on just mastopexy and reduction surgeries, where he was getting really great outcomes, and is using the mesh in all kinds of different ways. This is a powerful device that allows the surgeon to really control the inframammary fold, for example. When you anchor the mesh down, that is where the fold is going to stay. He’s got some results that are out 4 plus years and those results are maintained. Because of the success in lifts and reductions, another area where he’s found the mesh to be useful is in primary augmentations. In the 3.0 device, one of the options is a more rectangular shape with the rim. What he’s finding is that with a small inframammary incision, he can create his pocket and rather than fuss with a little piece of mesh and trying to tack it down, he places this and anchors it at the mid-line, at the inframammary fold. The mesh, which will be incorporated very quickly over a period of about 6 weeks, then provides excellent support. As a result of this, he’s been able to give gals a slightly larger implant than he would have been comfortable with in the past and, so far, there has been no incidence of pocket stretch. It’s pretty exciting.