Polydioxanone Internal Support Matrix: A Rationale for Prophylactic Internal Bra Support in Breast Augmentation.

[BACKGROUND] Textured breast implants have been used in aesthetic breast surgery to decrease the rates of implant malposition. A recent analysis of a large-volume single-surgeon experience found statistically similar rates of malposition in smooth vs micro-textured breast implants.

[OBJECTIVES] Prophylactic use of a polydioxanone (PDO) internal support matrix in breast augmentation was hypothesized to prevent scar malposition and increase pocket control.

[METHODS] In total, 200 patients received silicone gel primary augmentations performed by a single surgeon from January 2018 to December 2020; 84 patients received smooth implants alone; 49 patients received micro-textured implants; and 67 patients received smooth implants plus PDO internal support matrix. All surgeries were performed in the dual plane using an inframammary incision. Implant-related complications and scar malposition were recorded and compared.

[RESULTS] No significant difference in implant-related complication rates was found between shell types (3.57% for smooth devices alone and 2.04% for textured devices [ = 0.62; 95% CI -0.06 to 0.01]). There were zero complications in the smooth plus mesh study arm. A comparison of scar malposition rates between the smooth alone and textured groups revealed no significant difference (15.4% for smooth devices and 8.16% for textured devices [ = 0.23; 95% CI -0.12 to 0.01]). The smooth implant group with the prophylactic placement of PDO mesh had the lowest scar malposition rate of 4.48%, a significant difference compared with the smooth devices alone ( = 0.03; 95% CI -0.21 to -0.01).

[CONCLUSIONS] Micro-textured devices show a trend toward decreased scar malposition, although not significant. Prophylactic use of PDO internal support matrix in silicone gel breast augmentation is safe and has the lowest incidence of scar malposition.