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Internal Titanium BRA for a Long Lasting Solution against Breast Ptosis!
Ziya Saylan, MD; Dusseldorf, Germany
Since the first breast reduction surgery performed in early 50’s increasing demand for better results with minimal scars and improved anterior projection in breast reduction and augmentation surgery has lead to numerous techniques, such as short vertical scar, periareolar procedures and mastopexies with mesh support. An internal bra made out of nonresorbable materials such as ePTFE (Gore-Tex®) and polyester (polypropylene) or resorbable materials such as Vicryl has been tried several times by the surgeons in Brazil but the results have not always been satisfactory. In Europe the surgeons were trying an “internal bra” technique which has the effect of creating an internal bra using strong, permanent suturing materials. The most common problems were inadequate anterior projection, hardening, foreign body reactions, persisting postoperative large breast sizes and unsatisfactory density of the breast tissue.
An internal support will maintain an ideal postoperative breast shape and projection which also permits a long lasting support and projection of the breast by counteracting gravity. Many colleagues have performed breast reduction surgeries inserting absorbable and non-absorbable materials into the breast with complications. Since almost 2 years the author inserts a home made internal BRA out of titanized polypropylene- a mixed mesh which is called TiMesh®(GfE– Gesellschaft für Elektrometallurgie in Nürnberg, Germany) and used in Germany mainly in inguinal and abdominal hernia repair which shows no foreign body reactions in compare to other mesh grafts. This so called internal titanium bra will be suspended to the pectoralis muscle, sternal bone and to the ripcage.
Titanium coated polypropylene material is used in surgery primarily because of its excellent body acceptance. Titanium is accepted by the human body and is tolerated over the longer term as well. Thousands of hip, knee joint and dental prosthesis made of titanium are implanted every year. This titanium coated mesh consists of synthetic material, which is an indispensable component of modern hernia surgery due to its flexibility. The titanium atoms are chemically bound to the synthetic material so that the layer can not be detached. The skin and the breast tissue are only in contact with the biocompatible material. Also placing the mesh as a sandwich between the dermal flap and the breast tissue holds the loosened tissue like a purse-bag and gives it a better projection.
The previously into the body inserted absorbable and non-absorbable synthetic grafts have shown many advantages but also the risk of a foreign body reaction, hardening and even in extreme cases secondary infections. As the polypropylene was coated with titanium vapour which is a biocompatible metal the problem of hardening and inflamation was solved.
Surgical technique and Insertion of the titanium Bra
Marking is very important. The superior, lateral, medial and inferior borders of the breast has to marked previous to surgery in sitting position. Afterwards the surgeon has to make his own markings to plan and determine the future size of the breast positioning the areola and the inframammary fold.. At the same time the periareolar marking shape has to be performed reagarding the amount of elevation and positioning of the areola. Following a peri- or subareolar incision and sometimes a wedge formed excision (large breasts) of the breast tissue or a breast implant insertion in order to shape the breast the titanium bra has to be prepared. The skin flaps will be dissected in all directions so called “Undermining” staying about 0,5 to 1 cm subdermally in order to preserve the dermal vessels and to avoid skin necrosis. The dissection has to be continued until the fascia of the pactoralis muscle is visible and at the medial border the sternal bone or the ripcage is also palpable.
The GfE Company (Timesh®) which is also present in the USA and UK delivers a 30 x 30 cm size square material which weighs about 35 gramms has to be cut individually and tailored for each patient seperately. The surgery is done in twilight or general anesthesia in half sitting position (45 degrees) in order to construct an optimal anterior projection.