Central Pedicle Breast Reshaping Combined With Poly-4-hydroxybutyrate Scaffold Reinforcement: A Technical Description and Preliminary Single-surgeon Experience
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Published on: May 17, 2024
Guilherme Bracco Graziosi1, André Luiz Viana Nery1, Benedito Begnailson Ribeiro1
1From the Nery & Graziosi, Cirurgia Plástica Ltda., Niterói, Rio de Janeiro, Brazil.
Background:
Breast shape remains a persistent challenge following mastopexy, breast reduction, massive weight loss breast reshaping, revision surgery, and selected reconstructive procedures. The central pedicle preserves vascularized parenchyma, whereas poly-4-hydroxybutyrate (P4HB) scaffold reinforcement has been proposed as a soft-tissue support during postoperative remodeling. This study describes a single-surgeon experience combining these procedures.
Methods:
A retrospective review of an operative database was performed. Thirty patients undergoing breast reshaping using a central pedicle technique combined with P4HB scaffold reinforcement between June 2025 and April 2026 were included. Demographic variables, indication for surgery, mesh configuration, resection weights, and documented complications were analyzed.
Results:
The mean age was 42 years, and the mean body mass index was 24.8 kg/m2. This cohort included massive weight loss breast reshaping (18 patients, 60.0%), aesthetic mastopexy/reduction (7 patients, 23.3%), explant/revision procedures (2 patients, 6.7%), late breast reconstruction (2 patients, 6.7%), and immediate breast reconstruction (1 patient, 3.3%). No patients were smokers, had diabetes, had a history of breast irradiation, or had breast implants at the time of surgery. Follow-up ranged from 3 to 12 months. The most common scaffold configuration was the origami construct (70.0%). No intraoperative or postoperative complications were recorded. One patient experienced transient inferolateral mesh palpability that resolved spontaneously after 4 weeks.
Conclusions:
In this preliminary single-surgeon experience, central pedicle breast reshaping combined with P4HB scaffold reinforcement was feasible. No major complications were observed. Objective measurements of recurrent ptosis, lower-pole stretch, projection maintenance, and patient-reported outcomes were not collected, so no conclusions regarding durability or superiority can be drawn. Prospective studies with standardized outcome assessment are warranted.
