Upper pole support is really “a different animal” explains Dr. Bruce Van Natta of Indianapolis, IN. Much of what he has talked about on this site is about lower pole support using the P4HB mesh. But in a patient with a post bariatric breast or a deflated breast, sometimes only supporting from below just isn’t enough. So, another device that he’s had a good deal of experience with is called Refine Suture Suspension. This is a three suture system of permanent sutures. The top suture goes just under the pec fascia and then there are two vertical sutures with three little barbs. You pass those through the breasts and pull up, anchoring these little barbs. Then, you lift up and tie these sutures to the cross piece under the mesh at the pec fascia. It acts like a pair of suspenders. Refine is the best device that he has found for providing upper pole support. And it works really nicely with the GalaFLEX line. If you have the Refine providing support for the upper pole and the mesh providing support for the lower pole then the mesh doesn’t have to work as hard if the Refine is off loading and vice versa. He has had some pretty impressive outcomes that are now out 3 plus years, and finds that having both of these in his tool box is a big plus.