Long- Term Absorbable Synthetic Mesh in Breast Surgery

I first heard of the use of mesh in breast surgery almost 15 years ago at the ASPS's annual meeting in New Orleans. At the time the Binelli circumareolar mastopexy was all the rage. At a course on the topic, plastic surgeons from South America presented a circumareolar approach to mastopexy using standard heavy weight non- absorbable mesh as an internal brassiere. I thought this was an ingenious way to overcome inherently weak patient tissue. These surgeons did not use vicryl mesh because it would dissolve too quickly and thus not hold the breast up. I remember thinking how risky it was to use heavy weight, stiff, non-absorbable mesh in the sub Q plane of the breast. In recent years we have seen the increasing use of acellular dermis in breast reconstruction and the start of its use in some aesthetic cases. I have had the opinion for some time that synthetic long-term absorbable mesh would replace the use of acellular dermis. This is why I was pleased to learn this year about the introduction of the TIGR mesh by Novus Scientific. I have also been told that Dr. Becker had started using it in place of acellular dermis in skin and nipple sparing breast reconstructions.

I suspect that it will work as well or better than acellular dermis in breast reconstruction. Since it is about a tenth of the price of acellular dermis and because it is synthetic, instead of harvested from cadavers, I believe it could see wide spread use in cosmetic breast surgery. It is made of two different absorbable polymers that are knit together in a cloth like mesh. The first polymer dissolves over two weeks and the second dissolves in two years. Because the fabric is so supple it is easy to use support the infra mammary fold and the weight of an implant. Novus Scientific could probably manufacture it in "cup" sizes and shapes, along with attached sutures, to make the insertion and fixation easy. These internal brassieres could be used to hold up implants or the breast gland itself in mastopexy cases without implants.

Please see the link below for studies looking at the the long term histology of TIGR Mesh implanted in sheep. The TIGR mesh is made of absorbable polyester fibers that are twisted together into yarn, then knitted into a fabric. That means there are plenty of interstices for arterioles to grow into. This rapid ingrowth of vascularity may be why it resists infection. Then as the mesh gradually dissolves, organized type one collagen is laid down. This integration, followed by gradual resorption may be the reason for low capsular contraction. If long term human studies show the same collagen deposition seen in sheep, it may leave the host tissue stronger than it initially was!
http://novusscientific.com/tigr-matrix/tigr-matrix-us/
http://www.novusscientific.com/tigr-matrix/3-year-evidence/
http://www.springerlink.com/content/c033k26015677312/

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Comments

Dr Robert Rehnke's picture

Click the link below to see the "LARGE file video", using the TIGR Mesh to correct a failed mastopexy augmentation.

http://www.screencast.com/t/sIoxJUdHsdO

Eaweissmd@aol.com's picture

enjoyed the video and have never used that type of mesh before. on researching it, i do believe it is a viable alternative to alloderm/strattice(cost prohibitive). i have found that a limited capsulectomy of the inferior pocket, both anterior and posterior leaflets followed by a running 0 quill suture collapses the abnormal pocket and receates the IMF nicely. the quill is absorbable and not braided. however i have had the defect recur after this and i will try the tigr mesh in this situation, or if the tissue is too thinned out and i need the reinforcement. my personal preference is to stay away from ethibond because i have had late suture abcesses. which in this situation could be disastorous. i commend dr rehnke for introducing me to tigr mesh and this forum
eric weiss md

talevan's picture

Nice video, Robert! I had not heard of the TIGR mesh before and would be interested in seeing long term results. It sounds like it would be much more cost effective than Alloderm for implant reconstruction and also for treatment of symmastia. Thank-you for posting

RobertFrank's picture

Nice video...as referenced on this site I have a patent for a device very similar to the one you use in the video. I've done a few dozen patients with lasting results (longest is now 7 years out from bilateral bottoming out repair).

One interest of mine continues to be in improving results for periareolar mastopexy. The scars tend to be heavy and I believe that the tension on the skin is the primary culprit. I patented another device (Implantable prosthesis for periareolar mastopexy
US 7998152 B2) but it relied on Coapt endotine for fixation and when Coapt went bankrupt, the project stalled. Anyone done any work in a similar vein?

Dr Robert Rehnke's picture

Hey Dr. Frank. Thanks for your comments! I took a look at your patent and agree with you that a long term absorbable mesh/internal bra would be a great product. In the last two weeks I have fashioned three such "bras" from 2 dimensional TIGR fabric. It is cumbersome and time consuming. It would be great if Novus Scientific or one of the two big companies with long term absorbable mesh would pre make these 3-D prosthetics. How would you anchor them to the chest wall? Also, have you seen my IDEA about a 3-D sponge to replace the mastectomy specimen after skin/nipple sparing cancer surgery? After ingrowth of host vessels it could be transplanted with the patient's fat. Take a look at http://reconsurgical.com/tissue-engineered-breast-recon and post a comment.

Dr Robert Rehnke's picture

I had a great email discussion with Donn Hickman about his 14 year experience with the Goes technique I mentioned at the beginning of this post on using Long Term Absorbable Mesh in breast surgery. Donn published an article ( link below) on his extensive work on this technique without mesh. With the emergence of multiple Long Term Absorbable Mesh matrices, he is thinking of adding them for reinforcement to his procedure.


( http://www.screencast.com/t/qshqr9Y8gmk )