How Surgical Scaffolds are Used for Breast Reconstruction and Revision

Breast surgeons use surgical scaffolds during breast reconstruction or breast augmentation revision as a means to offer support where a patient’s own tissue cannot. Reconstructive and revision patients often have special surgical needs. Surgical scaffolds can help you attain your desired result and reduce the need for additional surgery.

Surgical scaffold materials used during breast reconstruction and breast revision

We can divide the four most commonly used materials into two categories: engineered mesh and acellular dermal matrix (ADMs). Each of these have their own advantages and disadvantages.

Acellular dermal matrix

Alloderm and Strattice are the two most often used ADMs in plastic and reconstructive surgery. Both are processed from dermal (skin) tissue, removing biological components to allow the donated material to support regeneration of the recipient’s own tissue. The goal of AMDs is the rapid absorption and regeneration of recipient tissue.

• Alloderm - Alloderm is processed from donated human dermal tissue. It is processed to maintain the essential biological components necessary to support regeneration of the patient’s own tissue. It incorporates rapidly with the patient’s tissue, with the goal being to minimize inflammation and scaring. This process starts quickly after the placement of the Alloderm graft and is usually completely absorbed within six months.

• Strattice - Strattice is processed from porcine (pig) dermal tissue. Like Alloderm, it is processed to maintain the essential biological components necessary to support the regeneration of the patient’s tissue. Strattice also incorporates rapidly with the patient’s own tissue through the same process of vascular regeneration and new collagen formation. The processing of AMDs removes components that may cause an immune response, allowing for minimal inflammation and scaring. The patient’s body starts the regeneration process quickly after surgery with Strattice, becoming completely incorporated at approximately six months. Because it is porcine tissue and not donated human tissue, Strattice has a lower cost to the patient.

Engineered mesh

Engineered mesh surgical scaffolds are a mesh material with a wider knit than ADMs. Seri and GalaFLEX are the two most commonly used surgical mesh for plastic and reconstructive surgery, but they are more often found in plastic surgery revision cases. Both products are newer to the plastic surgery market, meaning there are less long-term results available to show patient satisfaction rates over time.

• Seri Mesh- Seri mesh is a silk-derived bioprotein. Similar to ADMs, Seri begins to integrate into the patient’s body shortly after surgery. The material of Seri is bioreplaced over time with collagen from the body. This process is longer, with a large portion of the surgical mesh absorbed at 12 months and only traces left at 24 months. Though a mesh with a more open knit, the three dimensional pattern of the Seri mesh is quite strong for the immediate post-surgical period.

• GalaFLEX- GalaFLEX is the newest surgical mesh seen in breast augmentations and reconstruction. It is a naturally-occurring biopolymer knitted from P4HB (poly-4-hydroxybutyrate). GalaFLEX is a bit different in the fact that it is produced through a biologic fermentation process. There are other biopolymers used for medical purposes, but the composition of GalaFLEX makes it into a more flexible material with a moderate absorption rate and neutral biocompatibility (neutral reaction in the body). The wider knit, open pore structure of GalaFLEX encourages blood vessel formation as well as collagen formation. The properties of the specific biopolymer used for GalaFLEX allow it to be a strong mechanical support initially after surgery, while allowing for the slow break down as it is replaced by natural tissue made by the patient’s body. It is completely broken down to carbon dioxide and water, completely leaving the body by 18-24 months.

Cost of surgical scaffolds

The addition of a surgical scaffold often adds a significant cost to the patient. The pricing of each of the surgical scaffolds discussed here will range depending on the size of the sheet needed and the thickness. ADMs have several options for thickness, depending on the needs of the patient. Thicker sheets do have a higher cost. Alloderm, made from human dermal tissue, is more expensive than it’s porcine counterpart Strattice. Surgical mesh also range in price based on size, but they are of a standard thickness. Seri and GalaFLEX are at similar cost points, often comparable to Strattice. Because the price varies by size and thickness for these products, it will be important to get an individual quote from your surgeon.

An overview of surgical scaffolds

The chart below gives you an overview of surgical scaffolds, looking at material, absorption time, cost factors, size options and use.