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!