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I'm Dr. Richard Baxter. I'm a plastic surgeon here in the Seattle area. The procedure we're going to be doing today is a breast lift and we're going to be using a material that supports the breast tissue from the inside. It's called GalaFLEX mesh and the idea is that when we do a breast lift, we want to think of it three-dimensionally. We want to be able to not just move the nipple position up, but we want to be able to move the volume of the breast up and maintain it there and that's been one of the difficult challenges with breast lifting. There are different techniques that we use to try to accomplish that. Uultimately, they all rely on either the skin envelope or the ligaments in the breast to support the tissue. Those have already been stretched out so they're already weakened by definition, which is why we are doing the breast lift in the first place. The idea of implanting something in there to give extra support, I think, is a very compelling idea.

The material we're going to be using today is naturally-derived called P4HB and it will slowly reabsorb over time within the body and be essentially transformed into native tissue. So it comes in a... It's a flat material, it's a woven mesh. This is not the actual material itself. This is actually screen door mesh, but it's a handy material to play with to get used, trying to transform a flat piece of material into a three-dimensional support. I think it's just a handy trick for surgeons who are getting used to using that for the first time. What I have here is just a breast mold. This is a prosthesis. You can just order these online. I think it recreates a reasonably good shape. One option that's used a lot is to make this sort of a demi cup and it's a relatively simple thing to do. It, I think, does add good support particularly across the lower pole of the breast.

Sometimes, there maybe a little bit of a shelf that forms here. I've been experimenting more with trying to cone up the material. I'll start by making a slit here. I want to leave it intact across the bottom, but then if I get that overlap, then I've got a seam, which is not necessarily a bad thing but it also enables me to wrap it around further and even connect across the top of the nipple-areolar complex. That way you have circumferential support around the nipple-areolar complex. I'm not too concerned about having this seam here. If it's healthy tissue on each side, if it's breast tissue deep and subcutaneous tissue superficially, then I think having this overlap is okay. If it was placed against an implant, for example, then you would probably just want a single layer. The first step is going to be to set up the mastopexy like you ordinarily would. You'll de-epithelialize the pedicle. In this case, we're going to use a central pedicle technique. Develop your skin flaps.

You may need to do a little more wider undermining because you're going to want to get fixation to muscle fascia all the way around so be mindful of that. Then the next step is going to be fixing the mesh. We'll use a slowly dissolving suture material and I use interrupted sutures because A, it lets me adjust as I go better than I can with a running suture. B, if one of them releases too early or something like that, then I haven't lost the whole suture line. The first stitch I'm going to place is usually going to be at the central base, right at the bottom of where I will make that slit in the mesh. Because we have that long edge that's kind of drape around the intramammary fold followed up to the side and followed up medially, I'll start from the middle and then I'll tack as we go around. We want to make that slit in the mesh material. I already have it naturally set up to cone around the breast centrally.

Once I've done that, once I'm happy with the three-dimensional shape, then I can cut out the opening for the nipple-areolar complex. I will probably just tack the mesh together in a couple of places where it's overlapped along the bottom and then where it meets again at the top. I might use a more slowly dissolving suture there because those are more passive. They are just to hold the mesh in place. They're not the fixation that's holding up the entire breast. After that, then we just mature the skin flaps, re-drape. We have the opportunity to do the closure under really minimal tension because we've offloaded the weight of the breast onto the mesh rather than the skin envelope itself. I think there's a potential to get better scar in that way because we're taking the tension off of that closure. That's the key thing is make sure you're happy with the three-dimensional shape but you can create it without tensi

This Internal Bra Made From Mesh Material Called GalaFLEX Provides Additional Support For Sagging Breasts

Dr. Richard Baxter walks us through the process of creating an internal support system for a freshly lifted breast using a naturally derived mesh material called GalaFLEX.