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In the age of social media and with the overabundance of information out there about plastic surgery, terms like the “internal bra” have taken on a life of their own. Such ambiguous terms seem to raise more questions than answers for patients, which can feel ever-increasingly hard to find. At Dr. Megan Plastic Surgery, I strive to provide patients with accurate and up-to-date information about various plastic surgery procedures. In this post, I attempt to shed some light on a topic that has gained a ton of attention recently– the use of mesh in cosmetic plastic surgery procedures. Read on to learn the basics of surgical mesh, how it relates to cosmetic breast and body procedures, and the key factors I consider when assessing whether or not a patient is a good candidate.
What Is Mesh and How Is It Utilized in Plastic Surgery?
Surgical Mesh (for which there are many, many types of mesh) has been around for decades. At its most basic, it is a substance or medical device that is used to add additional support to tissue. Naturally, the tissue it is added to is usually weakened or damaged and in need of additional support. Surgical mesh is used all over the body from blood vessels, to abdominal wall hernias, to the pelvic floor. More recently, it has become popular amongst plastic surgeons for use in cosmetic breast and body surgeries. There are a couple of key features that are important when considering the use of mesh in cosmetic surgery. First, we want a substance that is flexible. Not only does flexibility allow the device to sit and move more naturally within the tissues it is placed in, but it adds to ease of inset for the surgeon which means less time in the operating room and better precision of placement.
Secondly (and arguably most importantly), we want a substance that adds strength to weak tissue. Now remember, there are many types of mesh products used in surgery. Some products are permanent, thus they add strength to tissue by their sheer presence (like plugging a hole in a leaking dam or patching up drywall). The surgical mesh products we use in Plastic Surgery, however, tend to be resorbable. Thus, they impart strength to tissues by alternative mechanisms.
Products like Galaflex and Durasorb (the two types I use the most) serve as a scaffold or lattice that encourage tissue ingrowth and increased collagen deposition and strengthening. When the products finally resorb, the tissue that has replaced it is stronger than native tissue.
Lastly, we want a substance that is biocompatible. Biocompatibility in this scenario means it's non toxic, doesn’t break down into toxic materials during its resorption process, and doesn’t incite a huge inflammatory reaction by the body. Basically, by causing less of a reaction by your own body, we decrease the chance of things like excessive scar tissue formation or infection.
When and Where to Utilize Mesh in Cosmetic Surgery:
Sorry to say, but the answer to this is going to be different depending on which surgeon you ask. It’s this variability of use that leads to the confusion patients feel when trying to assess their own candidacy for mesh placement. Below are the key factors I consider in my practice when considering mesh placement in a patient. Underscored in every point of consideration, however, is the question of whether or not additional tissue support/reinforcement is needed or indicated.
Tissue quality is by far and away the most important factor I consider. There are many reasons why someone might have poor skin/tissue quality potentially needing reinforcement. Factors such as pregnancy and breastfeeding, age-related changes, and weight fluctuations all subject the skin and tissues of the breast and abdomen (the two most common areas I consider the use of mesh) to loss of structural integrity and elasticity. Another important consideration is in the case of revisional surgery, where multiple procedures, incisions and scar tissue formation have created a loss of tissue strength.
When considering placement of a larger breast implant, the use of mesh even in a primary augmentation is an important topic to discuss in consultation regardless of a patient’s tissue quality. At the end of the day, larger implants equal heavier implants equals more gravitational force on the tissue over time. In such cases, mesh can be integral to maintaining long-term results.
Loss of abdominal wall fascial integrity in the case of multiples-pregnancies or massive weight loss may necessitate reinforcement of a diastasis repair with mesh to help decrease the risk of recurrence.
When I am seeking additional coverage of a breast implant in a thinner patient. In this scenario, we tend to worry about implant visibility and look for ways to make the tissue directly over the implant thicker. Fat grafting is an excellent option in most, but in thinner patient with little to no fat to graft, mesh may be our best bet.
Safety & Considerations:
As with any implanted material, safety is essential to consider. Although mesh is generally considered safe, is non-permanent, and has been extensively studied and refined over the years, no medical device comes without the risk of adverse outcomes. Potential risks include infection, fluid collection, palpability (being able to feel the mesh), and extrusion (the mesh working its way out of the body due to rejection of material).
Conclusions:
Surgical mesh has emerged as a valuable tool in cosmetic plastic surgery, contributing to improved outcomes and patient satisfaction when indicated. Whether used in body contouring or breast augmentation procedures, the strategic placement of mesh can enhance the stability and longevity of results. Despite its benefits, we must also consider the appropriate indications & risks as part of a tailored treatment plan. If you are considering a cosmetic surgery procedure, I encourage you to schedule a consultation with my experienced team. Together, we will explore your options, address your goals and concerns, and develop a personalized treatment plan to help you achieve your desired aesthetic goals.
To schedule your consultation with Dr. Megan today, call 206.860.5582. If you have comments or questions you would like answered in future blog posts, leave them in the comments section below.