The GalaFLEX "Empanada" for Direct-to-Implant Prepectoral Breast Reconstruction

Prepectoral breast reconstruction poses unique challenges, including a lower tolerance for mastectomy flap skin necrosis and seroma formation. With appropriate patient selection, prepectoral breast reconstruction is a valuable reconstructive option with numerous benefits. Although mastectomy skin necrosis is largely out of the control of the reconstructive surgeon, mitigation of seroma formation is critical. Strategies to reduce its incidence have been thoroughly discussed. Whereas there are many contributing factors, one tenet of prepectoral breast reconstruction is adequate pocket control. Reducing dead space and microshifting of the implant in the breast pocket is an important factor for averting seroma formation and implant displacement. Textured devices allowed the breast implant to sit more securely in the soft-tissue pocket. Given widespread concern for their involvement with breast implant-associated anaplastic large-cell lymphoma, macrotextured devices are no longer used in the United States. The authors describe their method of using poly-4-hydroxybutyrate synthetic absorbable mesh to effectively create a textured breast implant for use in prepectoral implant-based breast reconstruction.