Breast augmentation after bariatric surgery by using complementary prosthetic support for glandular containment

Introduction: The skin presents structural and proteomic changes after bariatric surgery and cannot withstand the weight of the breasts, which leads to early residual flaccidity, requiring auxiliary support. The goal is to apply a nonabsorbable polypropylene-poliglecaprone absorbable auxiliary mesh support or Bustos silicone sheet, in the form of an “internal brassiere,” to support the skin in order to maintain the shape and flaccidity of the breasts comparable with those of normal breasts. Methods: Nine patients underwent mammoplasty in inverted T with modeling of tissue implants, reduction of breast volume, and wrapping with an auxiliary support mesh. Results: Flaccidity was not observed at an early stage and the condition was acceptable for up to 4 years of follow-up. One of the patients had a seroma, which was drained with good resolution. Another 24 patients will be operated according to the protocol and observed for 2 years by using mammography, ultrasonography, and magnetic resonance imaging. Conclusion: Reduction mammoplasty after bariatric surgery requires additional support for the mammary gland. The structurally altered skin could not support the weight of the breasts, resulting in early flaccidity. ■ ABSTRACT

[1]  M. Śmietański,et al.  Systematic review and meta-analysis on heavy and lightweight polypropylene mesh in Lichtenstein inguinal hernioplasty , 2012, Hernia.

[2]  Anbok Lee,et al.  Outcomes of Breast Conserving Surgery With Immediate Vicryl‐Mesh Insertion: Is It Safe And Effective? , 2012, The Breast Journal.

[3]  D. Ostergard,et al.  Polypropylene mesh and the host response , 2012, International Urogynecology Journal.

[4]  K. M. Faucher,et al.  A review of the composition, characteristics, and effectiveness of barrier mesh prostheses utilized for laparoscopic ventral hernia repair , 2012, Surgical Endoscopy.

[5]  J. Park,et al.  Analysis of Infections Occurring in Breast Cancer Patients after Breast Conserving Surgery Using Mesh , 2011, Journal of breast cancer.

[6]  J. Lee,et al.  Results from Over One Year of Follow-Up for Absorbable Mesh Insertion in Partial Mastectomy , 2011, Yonsei medical journal.

[7]  Antônio Roberto Bozola,et al.  Análise geométrica da forma da beleza da mama e da forma de prótese baseado na proporção Phi: aplicação prática , 2011 .

[8]  J. Rubin,et al.  Mastopexy after massive weight loss: dermal suspension and selective auto-augmentation. , 2008, Clinics in plastic surgery.

[9]  B. Heniford,et al.  The Argument for Lightweight Polypropylene Mesh in Hernia Repair , 2005, Surgical innovation.

[10]  E. C. Lyra,et al.  The Application of Mesh Support in Periareolar Breast Surgery: Clinical and Mammographic Evaluation , 2004, Aesthetic Plastic Surgery.

[11]  J. Góes.  Periareolar mammaplasty: double-skin technique with application of mesh support , 2002 .

[12]  J. Góes.  Periareolar Mammaplasty: Double Skin Technique with Application of Polyglactine or Mixed Mesh , 1996, Plastic and reconstructive surgery.

[13]  R. Bustos.  Periareolar Mammaplasty with Silicone Supporting Lamina , 1992, Plastic and reconstructive surgery.

[14]  J. Goes.  Periareolar mammoplasty : double-skin technique , 1991 .

[15]  A. R. Bozola.  Breast Reduction with Short L Scar , 1990, Plastic and reconstructive surgery.