Discussion

Hundreds of thousands of implant-based breast surgeries are performed worldwide each year. Breast implant devices are numerous, ranging from gel to saline, smooth to textured, round to anatomic, and adjustable to non-adjustable. Just as many techniques exist as there are implant devices. No matter the type of implant or the technique used, complications may well occur. These complications often require another operation to correct the problem.

Figure 3 The TIGR Matrix

Figure 3 The TIGR Matrix

A recent 5-year follow-up of a line of breast implants showed a risk of reoperation of 23.8 %7. The use of acellular dermal matrices has become very popular in implant-based revision surgery8. A study by Spear et al showed that these matrices could be incorporated in the treatment of capsular contracture, rippling, implant malposition, and soft tissue thinning 9. The use of these matrices in revision breast surgery allow additional support to the lower pole of the breast and implant, extend the pectoralis muscle, and can smooth surface abnormalities 10.

In this article, the authors have reported on a case in which a patient had previously undergone a bilateral breast augmentation with implants and multiple revisions, including bilateral mastopexy by another surgeon. She was unhappy with the results and was seen in consultation for synmastia and breast asymmetry that worsened with muscle contraction. She was then electively taken to the operating room and had an augmentation revision performed using the new synthetic long-term absorbable mesh, TIGR® Matrix, as an alternative to acellular dermal matrices.

TIGR® Matrix is the first synthetic long-term resorbable surgical mesh. It is a copolymer of glycolide, lactide, and trimethylene carbonate. Pre-clinical trials of this mesh show that it is vascularised very rapidly and is replaced by well-organised host tissue11. The mesh became fully absorbed at 36 months post-implantation12. This gives it the ability to aid in tissue support for a long period of time. These qualities make it an ideal reinforcement in revisionary surgery after breast implant complications.

Figure 4 (A) 3 weeks postoperative result following replacement of implants in the sub-fascial position with mesh support and (B) 3 weeks postoperative, lateral view

Figure 4 (A) 3 weeks postoperative result following replacement of implants in the sub-fascial position with mesh support and (B) 3 weeks postoperative, lateral view

TIGR® Matrix was shown to be efficacious in the patient featured in this article who presented with a breast implant complication. Excellent functional and aesthetic improvements were made with the revision. To date,  the authors have used this surgical mesh in over 40 breast revision cases with very good results and patient satisfaction. The authors continue to find new ways to use it in breast surgery, such as primary reconstruction, reconstruction revision, augmentation/mastopexy revision, and breast implant revision  and are consistently happy with the results.

Conclusions

Based on the case presented in this article and other cases like it, the authors believe the long-term synthetic resorbable mesh, TIGR® Matrix, is a very useful tool in the correction of certain complications resulting from implant-based breast surgery. However, for patients who have undergone radiation treatment, the result can be slower healing and incorporation of the mesh implant. Further studies on the uses of the TIGR® Matrix are ongoing.