Purpose <p>The P4HB scaffold (GalaFLEX) is an effective tool in breast reconstruction, but its role in cosmetic breast procedures, such as mastopexy, requires further evaluation. We performed a proportions meta-analysis to assess the efficacy and safety of P4HB scaffold use in aesthetic breast surgery.</p> Methods <p>A systematic literature search was conducted in PubMed, Cochrane Library, and Embase through December 2024 for studies on cosmetic breast surgery using the P4HB scaffold that reported safety and efficacy outcomes. A random-effects model and Freeman–Tukey double arcsine transformation were applied. Statistical analyses were performed using R version 4.1.2.</p> Results <p>Three studies with 406 female patients (average age 39) were included, with mastopexy and augmentation–mastopexy being the most common procedures. Pooled analysis showed a delayed wound healing rate of 5.94 per 100 (95% CI: 0.34–16.62%), recurrent implant malposition at 0.47 per 100 (95% CI: 0.00–1.58%), infection at 0.42 per 100 (95% CI: 0.00–2.47%), seroma at 0.31 per 100 (95% CI: 0.00–1.32%), recurrent capsular contracture at 0.18 per 100 (95% CI: 0.00–1.21%), scaffold palpability at 0.11 per 100 (95% CI: 0.00–0.93%), and red breast syndrome at 0.00 per 100 (95% CI: 0.00–1.22%).</p> Conclusion <p>This meta-analysis suggests that the P4HB scaffold may be a valuable adjunct in aesthetic breast procedures, potentially reducing complications such as implant malposition and capsular contracture, while showing low rates of other complications including delayed wound healing, infection, and seroma.</p> Level of Evidence II <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>