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GALAFLEX USE IN THE COMPLEX PATIENT: MASTOPEXY, AUGMENTATION REVISION AND FAT GRAFTING BREAST PLASTICS CASE REPORT ARCHIVES MARCH 2014 Dr. Bruce Van Natta Meridian Plastic Surgery Center 170 W. 106th Street Indianapolis, IN 46290 Overview A 2012 report from the American Society of Plastic Surgeons states that 51% of cosmetic patients are repeat patients, while 46% of patients have multiple cosmetic procedures at the same time. As the number of patients who have had breast implants continue to increase and age, the need for revisional procedures increases. It is not uncommon for breast revision patients to have multiple surgeries, in part because the previously available techniques have been limited in their ability to provide long-term solutions that prevent recurrent ptosis. Fortunately, surgeons today have more available techniques and devices to be able to provide better solutions for long term outcomes than ever before. Case Background is communication describes the surgical plan and soft tissue reinforcement technique using GalaFLEX in a complex revision performed by Dr. Bruce Van Natta, of Meridian Plastic Surgery. e patient is a healthy 50-year old with a history of two previous breast procedures: she had an augmentation in 1990 and a revision in 2004 for recurrent ptosis and a deflated implant. In early 2014, the patient requested surgery to repair what she described as a “wide space between her breasts”. Dr. Van Natta chose to use GalaFLEX, a naturally derived, long-term resorbable scaffold that is FDA-cleared, to provide soft reinforcement in the patient’s breasts. GalaFLEX is made from poly-4-hydroxybutyrate and provides a high-strength, porous scaffold for native tissue ingrowth, before it ultimately resorbs in 12-18 months, leaving behind a repair site that is 3-5 times stronger than one without GalaFLEX. e surgical plan for this revision surgery was as follows: Dr. Van Natta is well-versed in the use of GalaFLEX as a transitory scaffold and believed it would help to elevate the breasts and achieve the long-lasting desired result that the previous surgeries, done without the use of a soft tissue reinforcement, did not give her. e surgical goal was to give the patient a small degree of lift through the inframammary mastopexy, maintain the lifted position of the breast mound with reinforcement from GalaFLEX, and enhance the overall shape of the breasts. 2 1 • Crescent and inframammary mastopexies • Implant exchange • Reinforce the capsule with GalaFLEX • Perform autologous fat grafting medially in the breasts to build cleavage
