Q: Dr. Eppley, I have been doing some research and I found some info on Refine Suture lift and mesh lift with fat grafting. I was wondering about these procedures and if you would suggest this over the traditional lift with implant. I have read that these help with the lifts lasting longer and upper pole fullness, but wanted a professional opinion.
A: Your research and questions into these developing methods of breast reshaping are timely and insightful and merit a full explanation to put them into perspective and how they may or may not apply to you and your breast reshaping goals.
While implants for volume increase and lifts for repositioning the breast mound and nipple upward are the traditional and time-proven methods of reshaping the deflated and sagging breast, they rely on a synthetic implant and scars to create their effects. So understandably alternatives have long been sought for either a more natural result (non-implant) and breast lifting methods that create less scars and more resistance to any lower pole breast relaxation.
Historically these searches for improved breast reshaping methods have been met with disappointment. But the three techniques you have mentioned (fat grafting, Refine anchors and internal mesh supports) have recently come into play and are promising…although they are still in various stages of development. Thus their use does not have a long track record so the initial enthusiasm must be viewed with guarded optimism.
Fat grafting can work in restoring volume to the deflated breast but what it can only achieve moderate volume increases. Fat grafting can not create large increases in breast size. This translates into an implant volume of about 200cc or less. If one has enough fat to harvest, then fat grafting can be a good substitute for this low volume increase which is usually perceived as ‘just adding a little extra upper pole breast fullness’. The only caveat about fat grafting is that its volume retention is not assured. As a genera statement, the volume of injected fat into a breast that survives and is maintained is around 50%…but some may have more or less volume retention.
Refine suture anchors for internal breast tissue suspension (internal breast lift) is based on placing a matrix of sutures with small plastic anchors that pull up the breast tissue upward and help anchor it to the upper pectoralis muscle fascia. As one of the few Refine-trained plastic surgeons in Indiana, I am very familiar with this device and its use. For small amounts of breast lifting, particularly in conjunction with fat grafting, it can have a useful role in breast lift surgery. But it will not provide a major lift when the transposition of the nipple-areolar complex must be moved significantly upward. In addition, its long-term effects are not well known as the device remains in clinical trials with long-term follow-up data yet to be reported.
The long-term stability of a breast lift is largely based on the skin tightening of the lower pole of the breast. This naturally relaxes to some degree in many breast lift patients, particularly when the breast mound is not supported by an underlying implant. The concept of adding a sling of support across the lower pole of the breast during a breast lift is both logical and has been tried in the past. But the use of non-resorbable synthetic meshes (hernia repair mesh) in the past has been met with wound healing and infectious complications. The concept has enjoyed re-emergence today because of a wide variety of cadaveric dermal slings and resorbable synthetic meshes. The two resorbable synthetic meshes currently available (GalaFlex and SIRI scaffold) offer a very adaptable thin mesh-like scaffold that be easily sutured across the bottom pole of the open breast lift patient. They are resorbable and are eventually replaced by new collagen tissue. Their use is gaining in popularity with good results and few complications and probably better long-term breast shape results. But they will not attain use in every breast lift patient as the cost of the mesh is around $2000 per breast. This adds substantially to the overall cost of the surgery which currently limits their use to the high-risk or revisional breast lift/implant placement.
Dr. Barry Eppley