Use of GalaFLEX Mesh in Mastopexy Augmentation
In this video, Dr. Bruce Van Natta of Indianapolis, IN demonstrates how to use the GalaFLEX mesh in a mastopexy augmentation. He starts by showing the points of fixation. He uses a flat piece of mesh although now, there is also the GalaSHAPE, a 3-D oval, and the GalaFORM, a 3-D oval with a rim. If you don’t have access to the two newest options, you can use the flat mesh which he has cut into two pieces with tabs. You can see that he has a sizer in place. His typical approach is to go after the 6 o’clock position. He always likes to mattress through the tabs. He thinks that it provides more strength. He emphasizes that the first bite is pretty much down to the ribs. He can lift the patient off the table. He knows that he is really going to be able anchor that fold and maintain the position of that fold. That is really part of the power of this mesh. There is a bit of extra material. He will often go back and trim these off. Occasionally when you tie these in, you will get a little bunching. It might be a little palpable, but it’s not a problem as the mesh will dissolve quickly.
Laterally, he places the suture in the area of the serratus. That’s the one weak link in terms of getting good, rigid fixation, but if you’ve anchored at the 6, 4, 5 and 7 o’clock positions, he doesn’t think it will matter. Or it hasn’t show to matter clinically. He is about 1 centimeter to 1 1/2 centimeters off the actual incision. You don’t want mesh right at the T in case of a breakdown. He uses 2-0 PDS. It’s what he’s used since the beginning and it seems to work well. Sometimes, when you place the 2-0 PDS, you’ll get a little bleeding, as you can see, but once you tie it down, it goes away. Getting these 5 sutures in place is standard technique for both the flat and shaped mesh. You can see that he has a little pleat and this is one of the problems with using the flat sheet. He simply puts in a few sutures to try to shape that flat mesh. It’s not as good as the GalaSHAPE or GalaFORM, but it’s better than nothing.
Then, he takes some vicryls and anchors to the parenchyma. He demonstrates how you can cut out a little mesh so that you are not too close the areola. Sometimes, he will tuck some of the parenchyma down into the mesh so that it’s acting a little bit like an internal bra. People have asked whether, when you close this, do you get some bulging or overfill from the top where the soft tissue is coming over the top of the mesh? While it may look like that on the table, once you close the flaps, it seems to constrain it.
He places the implant. He will usually take a vicryl and tack that down so that he doesn’t have the mesh in direct contact with the implant. Any little folds like you see here tend to work themselves out. The mesh has enough stiffness that it will hold its position. He has learned not to take out as much skin as he used to because you aren’t counting on the skin to do the work. The mesh will support the soft tissue so he now marks a lot less skin so only as much skin as he would need. You can see that the fold is fixed. You want to leave patients on the table how you would want to see them long-term. He recommends that with your first 20 cases or so that you sit the patient up to be sure that you like the position because it is easier to fix any issues on the table than latter.