Monday, November 4, 2002 - 5:00 PM

The Application of Mesh Support in Periareolar Breast Surgery: Clinical and Mammographic Evaluation

Alan Landecker, MD, Eduardo C. Lyra, MD, Leonardo J. Henriquez, MD, Renata Sampaio Ges, BS, Paulo Godoy, BS, and Joo Carlos Sampaio Ges, MD, PhD.

Introduction: Numerous different techniques have been described for the treatment of breast hypertrophy and/or ptosis. Unfortunately, recurrent ptosis after mammaplasty can occur regardless of the employed technique. To avoid this problem, different kinds of supporting devices have been described with variable rates of success. In the periareolar double-skin technique for mammaplasty and mastopexy proposed by the senior author, a mixed mesh composed of Poliester and Polyglactine 910 is applied before redraping the skin over the newly shaped breast architecture. By inducing a scarring reaction which functions as an internal brassiere, the mesh helps maintain long-lasting anterior projection and helps avoid the recurrence of ptosis. However, the true implications of incorporating mesh into breast surgery have never been clarified and surgeons have been reluctant to apply any kind of prosthetic material onto the breast fearing inflammation, an unfavorable aesthetic outcome, palpable or visible deformities, and interference with the mammographic evaluation of breast cancer. In this paper we analyze the aesthetic, clinical, and mammographic implications of utilizing mesh as a supportive device in periareolar breast surgery. Method: Eighteen (18) patients (mean age=42), with breast hypertrophy and/or ptosis were submitted to the double-skin periareolar mammaplasty technique, with placement of mixed mesh. Clinical assessment was performed by three breast surgeons who knew that the patients had had mesh application and were actively working on cancer surveillance. After a mean follow-up period of 30 months, a standard mammogram was performed in each patient and analyzed by both the surgeons and an expert radiologist. The evaluated factors were hyperemia, calcifications, contour irregularities, capsular contraction, thickening and/or widening of the scar with extrusion of the mesh, and any palpable and/or hardened areas. Results: According to our clinical observations, there were no mesh-related abnormalities in the breast, the mesh was not palpable after the operation, and there was no recurrent ptosis. In terms of mammographic imaging, the mesh was visible as a very fine line in the periphery of the breast's parenchyma (measuring 0.2 mm on the lateral views) in three patients (17%). The mesh did not interfere with the visualization and analysis of the breasts parenchyma. In seven patients (39%), benign localized microcalcifications were detected in the breast and no further investigation was carried out. In two patients (11%), grouped calcifications were detected and biopsied; histopathologic analysis demonstrated epithelial hyperplasia with atypia. In two patients (11%), nodules smaller than 1 cm were detected and biopsied; histopathologic analysis demonstrated a fibroadenoma in one patient and an invasive ductal carcinoma in the other. Conclusion: The periareolar mammaplasty with mesh support is capable of producing excellent and long-lasting aesthetic results. The presence of mesh does not induce visible or palpable deformities and mammographic abnormalities. In terms of surveillance mammograms, the presence of the mesh did not interfere with the diagnosis of minute lesions such as calcifications and small nodules.

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