Breast Surgery Scaffolds, Ranked: My Favorites, My Least Favorites, and Why

I get asked all the time: what exactly is a scaffold, and what are the different options? In breast and plastic surgery, a scaffold is a product we use during breast surgery that supports the breast in some way. There are a lot of options, and I have strong opinions on them. So let me walk through the major ones and tell you, honestly, which I love and which I can't stand.

First, one thing that applies to every single one of these: they are all off-label in the breast. That's always important to keep in mind, and worth a real conversation with your surgeon.

The very first type of scaffolding we used in plastic surgery was Acellular Dermal Matrix, and it's made from human (cadaveric) tissue. There are several brand names:

• AlloDerm
• FlexHD
• Cortiva

ADM is still commonly used, but less than it used to be, and the biggest reason is simple: it's very expensive. If insurance doesn't cover it, it becomes cost-prohibitive for most patients.

For patients paying out of pocket, like most cosmetic patients, there's a porcine (pig) dermal matrix, not human, called Strattice, that's less expensive.

I'll be blunt: I hate this product, and a lot of breast surgeons feel the same. It's very stiff, it behaves strangely, and I don't think it does what it's supposed to do very well. It would never be my first choice. If I'm going to use a dermal matrix at all, I'd reach for one of the human products instead.

The next big category is synthetic products, the meshes. These split into two very different camps: ones that dissolve and ones that don't.

There's one non-dissolvable mesh people used routinely in breasts, and it was an epic disaster: SERI Scaffold. It's now off the market. It's a little before my time, so I never implanted it, but I've taken it out, and it's pretty terrible. This is a good reminder that "permanent" mesh in the breast has a bad track record.

The dissolvable meshes are where it gets good, some of them are genuinely awesome. Here's my ranking:

GalaFLEX (P4HB), my favorite. This is the one I keep in my office and reach for. I love it for two real reasons: as GalaFLEX dissolves, your body produces an anti-inflammatory and an anti-microbial peptide. Both are good things. As a result:

• We see fewer seromas with GalaFLEX
• I think it helps with capsular contracture through biofilm mitigation

TIGR (TIGR Matrix), my close second. Another excellent dissolvable product. It contains two different types of suture material, and along with GalaFLEX, it's one of my two favorite absorbable scaffolds. (For how these dissolvable products behave over time, see mesh vs. dermal matrix and settling.)

DuraSorb, not for me. This is a commonly used dissolvable mesh, and it's my least favorite of the dissolvable options. Some surgeons love it, but I don't think it works very well.

OviTex, also a pass for me. OviTex is made from sheep rumen. I don't have much personal experience with it, and some people do like it, but it has a poor reputation in my breast-surgery friend group, the big knock being that it can turn to goo. Not my first choice.

Choosing to put a scaffold in someone is a real decision, not a default. When I'm in the operating room, three things drive it:

1. Have a good reason. You never want to use a foreign body if you don't need to. No scaffold "just because."
2. Cost. These are expensive, and I want to use something a patient can actually afford without financial peril.
3. Predictable results. I want something I have experience with that gives good, predictable outcomes, not a product I'm experimenting with on you.

If you want my honest scorecard on breast scaffolds:

My two favorites:

• GalaFLEX (the winner, anti-inflammatory + anti-microbial as it dissolves, fewer seromas, contracture help)
• TIGR Matrix (excellent dissolvable second choice)

The three I like least:

• Strattice (stiff pig ADM, an awful product in my view)
• DuraSorb (I don't think it works well)
• OviTex (sheep rumen, bad reputation for turning to goo)

And the cautionary tale: SERI Scaffold, a non-dissolvable mesh that was an epic disaster and is now off the market.

Every one of these is off-label in the breast, so the real takeaways are the ones that don't depend on brand: use a scaffold only when there's a good reason, pick one that's affordable, and choose one your surgeon has real, predictable experience with. For me, that's GalaFLEX, every time.