Synthetic mesh in the complications of breast cosmetics surgery

Introduction Breast augmentation is currently the most common cosmetic procedure performed in Italy. Despite the continuous improvements performed by the manufacturers who provide materials with a high biocompatibility and by the surgeons who developed techniques aimed at preserving the anatomical planes, this surgical procedure is not free of complications, with 15-30% of patients undergoing a revisional surgery in the 3-6 years following the primary procedure. Revisional procedures, aimed at reinforcing the weakened anatomical structures, include the use of acellular dermal matrices (ADM) or synthetic meshes. The aim of this study is to report our outcomes following the use of a synthetic mesh (Tiloop) in the treatment of breast augmentation-related complications. Materials and methods We performed a retrospective study including 123 patients who underwent breast augmentation revisional surgery and/or mastopexy with the aid of a Tiloop mesh at our Institution between March 2012 and May 2019. We collected data on the original position of the implant (subpectoral or subglandular), the date of the first surgery, the previous access route used, volume of implant used and date of the revision surgery. Age, lifestyle habits linked to direct trauma, pregnancies and/or weight loss and weight gain, type of implant and access routes used by us, duration of follow-up, and any complications were also reported. Results Patients' average age was 37.4 years, and of these 65% had had at least one child at the time of the first surgery. Almost half of the patients requiring revisional surgery showed a Baker III/IV level of capsular contracture (CC). More than a third, on the other hand, came to our attention for prosthetic dislocation. 85 patients had their original implant in the subpectoral position and 38 in the subglandular position. The average time between primary surgery and revision surgery was 5 years and 5 months. The mean follow-up after revision surgery was 5 years. No case of recurrence of the complication or of capsular contracture was reported. Of the 123 patients, 121 (98.4%) showed a soft implant with a Baker I level of CC at final follow-up; two patients (1.6%) had a CC Baker II. No patient showed Baker III or Baker IV at postoperative follow-up. Conclusions At date, there are no precise indications in literature suggesting reliable approaches to reduce the risk of recurrent complications after breast augmentation surgery. According to our experience, the Tiloop mesh showed to be an optimal tool to strengthen the restored implant pocket, as well as to protect soft tissues from prosthetic pressure in cases of rippling. This prosthetic device helps reduce unwanted prosthetic visibility and palpability and represents an important support to skin and soft tissues over time, thus slowing down the development of breast ptosis. Hence, the use of Tiloop non-absorbable mesh is a new and reliable surgical option in the management of breast augmentation-related complications.