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how I do it Principles of the technique Breast assessment after Breform surgery Most patients are marked up for standard Wise pattern incisions. The patients are positioned in a semi-sitting position. The surgical technique is a modification of Richard Moufarrege’s posterior dermoglandular technique [2]. Thick skin flaps are elevated up to the peripheral borders of the breast and down to the fascia, taking care to preserve branches of the intercostal nerves supplying the nipple. It is important to elevate the skin superiorly to the level of the second rib; the Breform mesh relies on secure fixation at the upper pole of the breast to support the breast. After reducing the breast, choose the appropriate mesh size with reusable sizers. The Breform mesh is fixed circumferentially to the chest wall with stainless steel skin clips (e.g. Conmed Reflex One). The skin flaps are re-draped and wounds closed over a drain. It is important that women are able to undergo routine breast screening and breast triple assessment, after aesthetic surgery. We have performed mammography, ultrasound, CT, MRI (even with stainless steel skin clips) and positron emission tomography (PET) [4]. Two patients have required breast core biopsy without problems. Breast cancer surgery and radiotherapy can even be performed on women with Breform. Postoperative care and complications Breform patients require standard postoperative care following a breast reduction / mastopexy. Wound problems are reduced after Breform, as the mesh takes the weight of the breast, and reduces wound tension. Postoperative seromas can occasionally occur. Results We have performed 80 procedures on 48 women (age 32-75); this is possibly the largest experience in the UK. The majority had aesthetic procedures, but some were cancer patients [3]. The longest follow-up in our series is five years. All patients have excellent cosmetic results. None have palpable mesh, and the breasts have remained soft. One breast cancer patient has received adjuvant radiotherapy to the breast after Breform mesh; her breast remains soft. Two thirds of women have stopped wearing bras after Breform. No patients have developed repeat ptosis. The incidence of complications is low – minor wound breakdown (10%), seroma (8%), haematoma (4%), infection (4%), nipple necrosis, palpable mesh and mesh exposure (all 0%). • Excellent technique for women with significant ptosis. • Patient selection as per normal mastopexy / breast reduction, except not in women who have not completed their families. • Operate on the patient in a semi-sitting position to get the optimal cosmetic result. • Ensure that the dissection is taken up to the level of the second rib, to allow secure anchoring of the mesh to the chest wall. • Breform mesh permits tension free closure. • Low incidence of complications. • Breasts remain soft, with no contracture. • Breform mesh prevents repeat ptosis. • Routine breast imaging and breast assessment (including MRI and core biopsy) unaffected by Breform mesh. pmfa news Learning points References 1. de Bruijn HP, Johannes S. Mastopexy with 3D preshaped mesh for long-term results: development of the internal bra system. Aesthetic Plast Surg 2008;32(5):757-65. 2. Moufarrege R, Beauregard G, Bosse JP, et al. Reduction mammoplasty by the total dermoglandular pedicle. Aesthetic Plast Surg 1985;9(3):227-32. 3. Chan C, Court F, Bristol F. Breform pre-shaped polyester mesh – extending its uses for cancer patients. EJSO 2016;42(5):S21. 4. Chan C, Court F, Humzah D, Bristol J. Postoperative breast imaging surveillance is unaffected by the use of Breform polyester pre-shaped mesh. EJSO 2016;42(5):S21. Section editor Dalvi Humzah, Aesthetics Sub-editor, Consultant Plastic Reconstructive & Aesthetic Surgeon, West Midlands / Worcestershire / Gloustershire; Plastic Surgery Rep, MAC Nuffield Health Wolverhampton Hospital; Bupa Cosmetic Clinical Lead; UK Regional Advisor (West Midlands), RCPSG. Keep up to date Editor’s note: Professor Andrew Burd This is a well written article that illustrates a technique and its tangible outcomes. However, I feel it is important to consider dynamics and the biochemical molecular changes in any mesh implanted in any part of the body. Hernias by the thousand, give an indication of biological compatibility of new materials and devices. But breast shape changes over time and how is the mesh incorporated into the connective tissue support matrix? Only time, and a wide variety of patients will tell, as there will be many biological variables involved. A good and thought-provoking article. follow us Facebook “f ” Logo RGB / .eps Facebook “f ” Logo #pmfanews RGB / .eps /PMFANews @pmfanews /in/pinpointscotland visit us at: volume 3 issue 6 I 37