Polydioxanone Internal Support Matrix: A Rationale for Prophylactic Internal Bra Support in Breast Augmentation

Background Textured breast implants have been used in aesthetic breast surgery to decrease rates of implant malposition. Recent analysis of a large-volume single-surgeon experience found statistically similar rates of malposition in smooth versus micro-textured breast implants. Objectives Prophylactic use of a Polydioxanone (PDO) internal support matrix in breast augmentation was hypothesized to prevent scar malposition and increase pocket control. Methods 200 patients received silicone gel primary augmentations performed by a single surgeon from January 2018–December 2020. 84 patients received smooth implants alone; 49 patients received micro-textured implants; 67 patients received smooth implants plus PDO internal support matrix. All surgeries were performed in the dual-plane using an inframammary incision. Implant-related complications and scar malposition were recorded and compared. Results No significant difference in implant-related complication rates was found between shell types (3.57% for smooth devices alone, 2.04% for textured devices [P=0.62, 95% CI -0.06–0.01]). There were zero complications in the smooth plus mesh study arm. Comparison of scar malposition rates between the smooth alone and textured groups revealed no significant difference (15.4% for smooth devices and 8.16% for textured devices [P=0.23, 95% CI -0.12–0.01]). The smooth implant group with prophylactic placement of PDO mesh had the lowest scar malposition rate of 4.48%, a significant difference compared to the smooth devices alone [P=0.03, 95% CI -0.21– -0.01%]. Conclusions Micro-textured devices show a trend towards decreased scar malposition, although not significant. Prophylactic use of PDO internal support matrix in silicone gel breast augmentation is safe and has the lowest incidence of scar malposition.