Experience and Indications for the Use of the P4HB Scaffold (GalaFLEX) in Aesthetic Breast Surgery: A 100-Case Experience

Aesthet Surg J. 2022 Dec 14;42(12):1394-1405. doi: 10.1093/asj/sjac198.


Background: The popularity of utilizing mesh in the breast has varied over the years. It is well described, and yet there has been poor uptake of its utilization in aesthetic breast surgery. Poly-4-huydroxybutarate (P4HB; GalaFLEX, Galatea, Lexington, MA) has recently been described as a useful adjunct in supporting poor tissue quality with positive early outcomes and low complication rates.

Objectives: The authors sought to determine the outcome and range of indications of PH4B in aesthetic breast surgery to document its effectiveness in assisting with long-term outcomes in mastopexy.

Methods: Firstly, an observational study was undertaken standardizing mastopexy techniques with P4HB included in the procedure. Photographic measurements were taken to determine the extent of lower pole descent and lower pole stretch at 3 months and 1 year postoperative to observe change over time. Secondly, other indications were explored, including the correction of secondary defects such as inferior malposition and symmastia.

Results: The results of the mastopexy study were highly encouraging and comparable with those previously published in the literature, confirming sustained stability of the lower pole over time for mastopexies and implant mastopexies. In addition, the GalaFLEX was successfully employed in correcting many secondary defects.

Conclusions: P4HB is extremely versatile and easy to utilize and has low complication rates. The results have led to a change in practice, with routine incorporation of GalaFLEX for all routine mastopexies. It has also replaced the utilization of acellular dermal matrices in aesthetic breast surgery.

Publication types

  • Observational Study

MeSH terms

  • Breast Implantation* / adverse effects
  • Breast Implantation* / methods
  • Breast Implants*
  • Breast Neoplasms*
  • Esthetics
  • Female
  • Humans
  • Mammaplasty* / methods
  • Mastectomy
  • Procollagen-Proline Dioxygenase
  • Protein Disulfide-Isomerases
  • Retrospective Studies
  • Treatment Outcome


  • P4HB protein, human
  • Procollagen-Proline Dioxygenase
  • Protein Disulfide-Isomerases