Many women who are seeking breast augmentation or breast lift want as much upper pole fullness as possible. For some women, the use of an internal bra (also known as a graft or sling) can help maintain the position of a breast implant or the breast tissue after surgery.
What are Dermal Slings?
When grafts or slings were first used in breast surgery, the most common type was a dermal allograft. This was skin from a cadaver that was processed to remove all living cells. Human and animal versions were created, and common ones were Alloderm (human), Strattice (pig), and Surgimend (cow). These products added support to surgery and coverage of implants when muscle was not available, but they had complications. Patients had a higher number of seromas (fluid collections around the implant), and some women developed an immune reaction called “red breast”.
Surgeons also used these grafts to reinforce weak abdominal muscles or to help in hernia repair. These were an alternative to non-dissolving or permanent mesh grafts (the kind you see the lawyers advertising about lawsuits on TV).
What are bioabsorbable Mesh slings?
Newer grafts/slings are now made of the same material as absorbable sutures. They dissolve and are incorporated into the body over 12-18 months. Examples are Galaflex and Durasorb. The complication rates are lower than the dermal slings since these grafts are thinner and finely meshed to decrease the chances of fluid collections and non-absorption of the graft.
Who benefits from using mesh?
Using mesh in patients after massive weight loss or with significant stretch marks can prevent the tissue from stretching after surgery by up to 20%. This can also help maintain the position of a breast implant.
Mesh can be helpful in breast implant revision surgery. If the pocket needs to be changed from above the muscle to below, the sling can help cover the bottom half of the implant and prevent it from moving into the old pocket. Grafts can also help correct inferior or lateral malposition, which means the implants sit too low or fall to the sides. Grafts can be critical for correcting symmastia (aka uniboob). The only limit of the grafts is that they are sutured to the body, and in some cases the graft can stretch away from the body and not function properly.
Mesh can also be helpful in cases of capsular contracture. After the thickened capsule is removed, the graft can help stabilize the position of the implant until the new capsule forms. Also, some studies show decreased rates of capsular contracture recurrence when grafts are used.
Does everyone need a sling?
Not necessarily! Many patients have strong enough tissue that a sling is not necessary. Given the cost ($1000-$2500). I usually offer grafts to the patients who could benefit from it the most.
Want to know what a graft looks like?
