Long-term Outcomes of Poly-4-Hydroxybutyrate (P4HB) in Aesthetic Breast Surgery: An International Experience

Background Poly-4-hydroxybutyrate (P4HB) is a component of human connective tissue and biomedically produced thermoplastic polyester scaffold that has been used in many surgical subspecialties. The utilization of P4HB in cosmetic and reconstructive breast surgery has been popularized internationally for the past 12 years. Objectives The purpose of this study was to assess and report long-term international outcomes of P4HB use in aesthetic breast surgery. Methods A standardized retrospective outcome review was completed from the records of 5 international surgeons, each with significant expertise in using P4HB. Results A total of 621 patients were included in the review. Average follow up was 1.33 years (Range: 1- 9.3 years). Most patients had P4HB placed during primary breast surgery (N=460; 74%); primary procedures included augmentation-mastopexy (N=253), mastopexy (N=125), breast reduction (N=71). A subset (N=161; 26%) of patients had P4HB placed during breast revisions; revision augmentation with mastopexy (N=81), revision augmentation (N=73), mastopexy with implant removal (N=7). Top indications for revision included recurrent ptosis (N=166), implant malposition (N=64), and capsular contracture (N=61). An overall complication rate of 3.7% (n=23) was observed, the most common being delayed wound healing (N=7) and hypertrophic scarring (N=5). Of the overall complications, device related complications associated with P4HB were observed only in 5 patients (0.8%), while non-device complications were seen in 18 patients (2.9%). Conclusions This study suggests there is a defined role for the use of P4HB in both primary and revision aesthetic breast surgery; its use does not appear to increase the inherent complication risk of cosmetic breast surgery.