Soft Tissue Support as an Adjunct to Implant-Based Cosmetic Breast Surgery: A 500+ Case Experience.

Background: Intraoperative techniques to maximize control are crucial to achieving an aesthetic result in cosmetic breast surgery with implants. The authors describe their experience with the use of polydioxanone (PDO) internal support matrix in a high volume of primary augmentation, primary mastopexy augmentation, and revision augmentation cases. Methods: A high-volume (n = 522) single-surgeon experience followed patient outcomes in consecutive cases from September 2020 to June 2023. All patients received smooth-shelled silicone gel breast implant augmentation surgeries with PDO mesh as an adjunct. Each case used at least 1 sheet of PDO mesh, with a small set (n = 9) receiving 2 sheets. Patients were followed (range 6-37 months), with 6 months minimum follow-up to assess outcomes. Results: PDO mesh is associated with decreased malposition in primary augmentation with smooth implants and improved scarring in primary and revision augmentations involving a mastopexy. Augmentations performed with PDO mesh as an adjunct allowed for the use of larger implant volumes with less concern over poor soft tissue stores and compromised skin quality to hold the weight of the implant. Conclusions: PDO mesh is a safe and effective adjunct to smooth silicone gel implants to obtain greater pocket control and optimal aesthetic results in cosmetic breast surgeries.