Artificial Intelligence, Genuine Outcome: Analysis of 72 Consecutive Cases of Subfascial Augmentation Mastopexy With Smooth Round Implants Supported by P4HB Scaffold.

Background: Ptosis recurrence often leads to unsatisfactory results after mastopexy, even more so when additional stress is provided by implants on compromised native tissue. The poly-4-hydroxybutyrate(P4HB) scaffold (GalaFLEX) with its favorable safety profile and proven long-term mechanical strength represents a preferred option for soft tissue support.

Objectives: The primary endpoint was assessment of lower pole stretch from the early postoperative period up to 3 years.

Methods: Out of 151 patients who underwent surgery by G.B. from March 2020 to December 2023, a total of 72 with a 12-month-mininum follow-up who had primary (46) or secondary (26) augmentation mastopexy with subfascial round smooth implants and P4HB scaffold support were included in the study. Three-dimensional artificial intelligence software was utilized for all measurements. Further analysis included evaluation of ptosis recurrence and all complications.

Results: No recurrent ptosis, bottoming out, implant displacement, or capsular contracture was reported during follow-up (mean, 24.8 months). The lower pole arch's elongation was 8.04% and 9.44% at 1 and 3 years respectively, comparing favorably with previous reports. Statistically significant correlation (P < .05) between implant size and lower pole stretch was noted, this being greater for larger implants (> 400 cc; P = .0011) and primary cases (P = .1376). Progressive volume redistribution from upper to lower pole was observed in the first year, with substantial stability thereafter.

Conclusions: This is the largest published series reporting long-term results (up to 45 months) in mastopexy augmentation with GalaFLEX, suggesting its supportive role in lower pole stability even in the setting of concurrent breast augmentation with smooth implants in a subfascial plane.

Level of evidence: 4: