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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. Though 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 1-3 . While there are many contributing factors, one tenant of prepectoral breast reconstruction is adequate pocket control. Reducing dead space and micro-shifting 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 (BIA-ALCL), macro-textured devices are no longer used in the United States. In this paper, we describe our method of using poly-4-hydroxybutyrate (P4HB; GalaFLEX Lite) synthetic absorbable mesh to effectively create a textured breast implant for use in prepectoral implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV
Karp et al. (Mon,) studied this question.