The use of mesh to support the breast as part of a mastopexy procedure has not been shown to produce results superior to standard mastopexy techniques. I can absolutely understand how it might sound to the layperson like a completely reasonable concept, but that does not mean it actually makes sense in clinical practice. I personally have not considered using mesh, as there are mastopexy techniques already available capable of producing aesthetically ideal breast lift results that are long-lasting – without the addition of a foreign object to the breast like surgical mesh.
There are numerous potential downsides to using mesh in a superficial soft tissue environment like the breast: infection, visibility, exposure – not to mention the additional expense. Most experienced mastopexy and augmentation mastopexy surgeons rely on internal breast soft tissue rearrangement to increase breast projection and maintain it over time. If a lot of surgeons were experiencing difficulty with creating aesthetically ideal mastopexy results and maintaining them over time, then a lot of surgeons would be considering the use of additional materials like mesh to shape and hold the breast. The fact that most board-certified aesthetic plastic surgeons are not turning to the use of mesh for mastopexy should give patients confidence in existing mastopexy techniques.
Look at before and after photos, which ideally should show results at intervals as long as one or two years postop. A breast the still appears lifted and aesthetically ideal at one to two years postop is a result that is going to hold up well over time. And you don’t have to use mesh to get that kind of result.
Mastopexies with an Internal Brassiere
In my experience, I started performing circumareolar lifts in 1998. At first I tried the Benelli mastopexy and the results were just OK. The marking techniques and the suturing of the areola are still techniques that I use today but the lift was unsatisfactory because it did not adress upper pole hollow, it did not add projection to the breast mound and importantly recurrence was high.
I subsequently started using the Goes Mastopexy with and without the internal mesh. Dr. Goes is a brazilian plastic surgeon who lifts the breasts from above. The breast tissue is pulled upwards and is anchored higher on the chest. This part of the procedure gave great upper pole fullness that was natural and durable. The second part of the procedure was designed to add projection and improve the shape by vertically imbricating the lower half of the breast. Although there was an improvement, I found that without the internal mesh, this aspect of the procedure was not as effective as other procedures I have tried. However, when adding the mesh brassiere, I saw a great improvement in the shape. The mesh is more expensive but worth it. I add the cost of the cost of mesh $1500 to the procedure.
If you would like more information on Goes mastopexies with an internal brassiere, please read my book "Cosmetic Breast Surgery - a complete guide from A to double D".
Every surgeon might answer differently. I have some reasons not to rush into this. Costs of mesh is usually high. Long term effectiveness is unknown and may fail like many of the thread lifts for faces have. And any foreign body can cause infection or foreign body rejection issues that can be a nightmare. A few early post op photo successes do not necessarily mean long term success.
Since the use of a synthetic mesh is not an absolute necessity to performed a successful breast lift, the question has to be raised as to what benefits the mesh brings versus what problems can it cause. It is important to remember that it is a foreign-body for a long time before it resorbs. Cost is a major issue with the use of mesh in breast lifts, often adding as much as $4000 to the cost of surgery. There is also a higher risk of infection and potential wound healing problems. Lastly there is the issue of whether it really offers better support and less bottoming out of the breast tissue 1 or 2 years from surgery. I am bullish on the use of mesh in breast lifts in particular since loss of lower pole support is a chronic problem. But it is very understandable why many plastic surgeons have taken a wait and see attitude towards it...since the long-term data in a large number of patients has not yet been forthcoming. Do not confuse an unwillingness to jump on a hot new fad or device as being out of touch...it is a matter of being cautious and looking out for patient's best interests.
To put things simply but honestly:
1. Extra cost to your patient that few are willing to pay for
2. Learning curve in the surgeons taking the time to develop new techniques and learn how to use it
3. No real firm data that supports it makes any long term difference in overall shape and satisfaction
In theory, it sounds like a great principal: give some support to your lift and hopefully it will last longer. I just don't see a huge benefit in its use- yet. Breast lifts may need maintenance from time to time, but choosing a surgeon with a great technique and great before and afters is the most important decision you will make.
Why aren't there more MDs using the new Breast Lift technique with a mesh?
This is a complicated question that does not have a straight forward answer. There are a lot of factors and variables associated with breast lift surgery--skin laxity, size, ptosis or droop of the breast gland, +/- implants, breast shape, patient goals/expectations, etc. Operations for breast surgery (and most cosmetic surgery in general) are customized for each individual patient depending on their goals, needs, etc. What is a good operation for one patient, may not be a good option for you or other patients out there. Currently, most surgeons are using a biologic dermal product (pig skin) for use as an internal support or internal bra for patients that have implants that are riding low and need to be lifted up. There are some newer semi-absorbable meshes that have recently come onto the market for the same purpose that are not skin/dermal products. For use in lifts alone, without implants, there are some surgeons that will implant a synthetic mesh that does not dissolve and use it to hold the lifted tissue up and secure it to the muscle; but in my experience most of my colleagues do not like to use this sort of synthetic mesh in the breast. It may not be as effective as they think and potentially places patients at risk of developing an infection with a foreign material that is permanent in tissue that can occasionally have bacteria in it (breast gland). This is the reason most surgeons have tended towards a biologic mesh that actually incorporates into and acts more like your own tissue; and there is a lower risk of infection. Finally, a peri-areolar breast lift is not for most patients as well. This type of lift is really only for women that have a mild degree of breast droop and only need to lift the nipple up about a centimeter or two. Maybe a tiny bit more if you push it. Trying to be too aggressive with this type of lift can result in a large, stretched out areola, flattened breast, and wide scars in some patients. Anything more than this small amount of lift is probably better served by either a vertical or full lift. Good luck!
Use your own tissue instead of mesh
There is a new technique called The Mini
Ultimate Breast Lift™.Using only a
circumareola incision it is possible to reshape your breast tissue creating
upper pole fullness, elevate them higher on the chest wall and more medial to
increase your cleavage.Aligning the
areola and breast tissue over the bony prominence of the chest wall maximizes
anterior projection without the use of implants.This technique avoids the ugly vertical scars
of the traditional technique, maintains nipple sensation and the ability to
breast feed.Foreign body mesh is not
required, which reduces cost and eliminates foreign body complications.
Gary Horndeski, M.D.