“Never Trust the Skin”: A Rationale for Using Polydioxanone Internal Support Matrix to Minimize Scarring in Primary Mastopexy-Augmentation—An Observational Study

BACKGROUND: The process of scar formation is complex and multi-factorial. Basic plastic surgery tenets focus on tension-free techniques to optimize aesthetic outcomes and minimize scarring. OBJECTIVES: Prophylactic use of a polydioxanone (PDO) internal support matrix in cosmetic mastopexy-augmentation to decrease scar burden has never before been described. METHODS: A high volume (n = 41) single-surgeon mastopexy-augmentation experience (S.S.K.) followed scar quality in consecutive cases from June 2020 to July 2021. A minimum of 6 months of postoperative evaluation was required to assess scar quality. Fitzpatrick scores were also evaluated and compared. All surgeries in this study were performed in the dual plane using silicone gel implants, a superior or superomedial dermal pedicle blood supply, and a wise-pattern or vertical scar. Scar quality was evaluated by photography and scored according to an internally developed scar quality scale. RESULTS: There have been no cases of hypertrophic or keloid scarring. All patients receiving mastopexy-augmentation with prophylactic PDO mesh have a favorable appearance with fine line scars, and the mean scar quality scale score across the cohort was 4.341/5. The mean Fitzpatrick scale score across the cohort was 2.97, and, of the patients who scored a 5 on the scar quality index, the mean Fitzpatrick scale score was 3.545. CONCLUSIONS: Prophylactic use of PDO internal support matrix in silicone gel mastopexy-augmentation offers further protection against poor scarring in patients across the Fitzpatrick scale, with varying degrees of skin quality, and across medium to high-volume implant augmentations. Patients who received PDO prophylaxis demonstrated a better-than-average scar appearance. LEVEL OF EVIDENCE: 4: [Image: see text]