New surgical breast techniques continually evolve over time, often taking their lead from breast reconstruction techniques. Some of the most common symmetry corrections needing to be addressed are those related to breast positioning as they relate to the patient’s chest wall, as well as how they relate to the stability of patient’s inframammary fold. Newport Beach female plastic surgeon Dr. Lavinia Chong has previously addressed these soft tissue failures with products such as Strattice and GalaFORM.
Dr. Chong now offers her patients an option which is so simple in design, yet offers great support and reliable performance at a patient-friendly cost. It is a soft tissue support product called DuraSorb Macroporous Monofilament Mesh. In simplest terms, DuraSorb helps your body to create a durable soft-tissue support system by means of a knitted mesh comprised of resorbable material, made up of components similar to that of dissolvable sutures.
Breast Reduction, Mastopexy, and Explant Surgery
DuraSorb is commonly used in our Breast Reduction, Breast Lift, and Breast Implant Explantation surgeries. In these cases, DuraSorb is used for soft tissue reinforcement whenever there has been antecedent stressors such as weight fluctuations and/or aging. Weight fluctuation stressors may not only be that of overall weight gain/loss, but may also include the stressors of increased breast volume during pregnancy/lactation and postpartum loss of volume.
Hypermastia or excess breast volume is also an indicator for DuraSorb use. In these cases, DuraSorb may be used to offer inferolateral support and medialization of the Nipple-Areolar Complex (NAC). With its use, DuraSorb has shown to provide overall improved outcomes: rounder nipple-areolar complex diameters remain preserved, and scar healing appears to be quicker, as there is less tension on the suture lines.
For breast Implant Explant cases, although aging and weight may not be the primary stressor, the introduction and subsequent removal of supplemental volume (removal of the saline or silicone breast implant) can have a similar impact on the condition of the breast tissue and skin elasticity.
Breast Implant Surgery (Augmentation and Exchange)
DuraSorb has also provided beautiful structural assistance for our Newport Beach Breast Augmentation patients diagnosed with hypomastia, poorly defined inframammary fold, asymmetry, and/or chest wall deformities. DuraSorb may be applied proactively as a solution to the potential failure of the soft tissues being able to provide a stable implant pocket following Breast Augmentation surgery.
For these cases potential soft tissue failures may occur as a result of antecedent stressors such as:
- Weight fluctuations … this may include weight gain/loss at any age;
- Aging related tissue changes resulting in breast ptosis (sagging breast);
- Symmastia (webbing of the intermammary distance, lack of cleavage);
- Inferolateral implant support (reinforcement below and along the side to bring in implant positioning);
- Medialization of Nipple-areolar complexes which may be traditionally laterally splayed (pointing out toward the side);
- Deficient soft tissue support necessitating an inframammary fold reinforcement (these are cases when a patient requests a larger implant than the patient’s anatomy can accommodate).
Implant Exchange surgery is one surgical procedure which combines a breast implant explant surgery with a secondary breast augmentation surgery whereby a breast implant is added to replace breast volume. During the explant portion of the surgery, there may be a removal of excess scar tissue (capsulectomy) which has led to capsular contracture. And modification of the “pocket” may be performed if the patient has chosen to downsize their breast implants to a smaller size/volume.
During the exchange, a DuraSorb sling may be added to the procedure when soft tissue reinforcement is needed to compensate for antecedent stressors as mentioned above when indicated during Breast Augmentation Surgery (i.e. weight gain/loss, age related sagging, when the selected saline or silicone breast implant size is more than the patient’s tissue can support, the breast implant footprint is narrowed, and when additional inferolateral support is needed to improve positioning of the implant and medialization of the NAC is desired).
The use of DuraSorb for a Breast Implant Exchange procedure may also be indicated in cases of Symmastia. Symmastia occurs when there has been an obliteration of the intermammary distance (a creation of the “uni-boob” or “bread-loafing”). In these cases DuraSorb can provide a basis for the reinforcement of tissue which defines an area of cleavage, a creation of visually independent breasts.
DuraSorb may also be used to reinforce areas of tissue in cases of capsular contracture. When an area of a capsule (scar tissue) is removed (capsulectomy), this area may result in a tissue quality which is deficient and not able to support the weight of the new implant. In this case, your breast tissue needs assistance with creating a durable support system. DuraSorb provides a means of support via an intertwined network of resorbable material, made up of components similar to that of dissolvable sutures.
Providing Additional Support to Soft Tissue
During the first month following the application of DuraSorb, the monofilament structure continues to provide tissue support while integrating with the neocollagenesis tissue (the tissue formation occurring as a result of the wound healing process).
Pictured above is a patient pre-op explant-mastopexy with DuraSorb (left), and 4 months post-op (right). At four months post-op, this new tissue becomes capable of providing full tissue support. And over the course of the year following surgery, the interwoven structure of DuraSorb is resorbable, similar to a dissolving suture. DuraSorb provides reliable results which are maintained due to the deposition of 1-2mm collagen.1
Frequently Asked Questions
Is Durasorb safe?
Yes. Although the technology is more recently developed, the methodology of its application in breast surgery is a new approach to tissue reinforcement, the materials used in the creation of DuraSorb have been used in surgery for over 35 years. It is clinically-trusted with a chemical composition of PDO (polydioxanone), a synthetic polymer, which is a constituent of suture material. This monofilament provides predictable absorption with distinct benefits:
- Decreased surface area that reduces bacterial adhesion, and;
- It is cost-effective and budget-friendly for patients in need in comparison to the price of other biologic and non-biologic materials used for the same purposes.
DuraSorb technology was developed with wound healing in mind. Over time, the product hydrolyzes and absorbs parallel to the tissue’s natural strength recovery and provides support during the healing process.
Will I feel where the DuraSorb has been used?
Palpability is unlikely. Remember, the goal of DuraSorb is to enhance the strength and recovery of your natural tissue. So by six months post-op, your tissue has become full weight-bearing as the DuraSorb continues to resolve the process of integration and absorption.
Will Durasorb interfere with my routine Mammograms?
No. Mammographic surveillance is not compromised. Please continue to observe your routine mammogram schedule as indicated by your provider. Please note, mammograms are required for women (age 40 and over) who are scheduled for breast surgery, or for women of any age with a history of breast cancer. Breast surgery patients are then advised to wait until they are one year post op to resume their mammogram schedule.
Do you use DuraSorb in all of your Breast Implant Explantation surgeries?
DuraSorb may be used whenever it is indicated. During your in-office consultation and/or pre-operative appointment with Newport Beach plastic surgeon Dr. Lavinia Chong, you will have an opportunity to review your surgical plan (which may include a capsulectomy, the removal of scar tissue). As part of your physical exam, breast and chest wall measurements will be taken. At this time, based on the condition of your breast tissue, and your anatomical structure, Dr. Chong will review whether she would consider DuraSorb as an option. DuraSorb can be of benefit during an explant surgery in cases when:
- Symmastia is present;
- If it is anticipated that the capsule removal will result in deficient tissue support;
- A breast which is naturally inclined to splay, needs inferolateral support, and when support is needed to assist with medialization of the Nipple-Areolar Complex (NAC);
- A lift is suggested to address ptosis, or a case when the implant has bottomed out and additional support is needed to reconstruct the inframammary fold.
I’m having an Implant Exchange, and one of my implants has bottomed out…would DuraSorb help me?
Yes. DuraSorb can be used any time the breast tissue is needing a bit of reinforcement. Even if you are exchanging for a similar size or smaller implant, an area where the implant has previously bottomed out can benefit from the promotion of a stronger area of tissue regeneration and creation of a new inframammary fold.
Consultation and Surgery
Surgical candidates are non-smokers, who are at a healthy weight, and are in good health. You may complete a health history review prior to your consultation by downloading, completing the forms, saving, and returning to your Patient Care Coordinator via email. Once we have received your forms, a member of your surgical team will call and review your history, to help you determine if there are any items which would need further assessment and clearance by your primary care doctor, or treating specialist, prior to scheduling consult/surgery.
Patients have two options for consulting with Dr. Lavinia Chong. Patients may call (949) 644-1400 to request an in-person consultation at our private surgical suite in Newport Beach, California. For patients living outside of the Orange County area, and for patients on a tight schedule, virtual consultations are also available via video chat on a HIPAA-compliant, fully-encrypted platform called Google Meet. Google Meet allows patients to join their appointment via computer (desktop or laptop), or by mobile device (smartphone or tablet) via a unique link which will be emailed/texted prior to your appointment. We look forward to meeting with you!
References
- Durasorb macroporous monofilament mesh. SIA (Surgical Innovation Associates). (n.d.). Retrieved February 7, 2023, from https://sia.health/products/
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