Pocket Reinforcement Using Acellular Dermal Matrices in Revisionary Breast Augmentation

Kaufman and Clark Plastic Surgery, 2220 East Bidwell Street, Folsom, CA 95630, USA.
Clinics in plastic surgery (Impact Factor: 0.91). 04/2012; 39(2):137-48. DOI: 10.1016/j.cps.2012.02.001
Source: PubMed


Revision breast augmentation to treat implant malposition is fraught with challenges. This article focuses on treatment of implant malposition by using acellular dermal matrices (ADMs) with the intent of creating more reliable and accurate results. The article discusses the use of ADMs in patients with breast implant complications such as bottoming out, lateral implant displacement, or synmastia. ADM is a foreign material, thereby adding potential complications to consider.

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    ABSTRACT: Background: Augmentation mammaplasty and augmentation mastopexy are associated with a substantial primary and secondary revision rate. Capsular contracture (CC), implant malposition, ptosis, asymmetry, and rippling are the main reasons for revisionary surgery in these patients. Traditional corrective techniques have not been completely reliable in preventing or treating these complications. Recently, acellular dermal matrices (ADM) have been used to assist with revisionary surgery with promising results. Objective: The authors review their 6-year experience using ADM for revisionary surgery in aesthetic patients and evaluate long-term outcomes with this approach. Methods: Patients who underwent revisionary breast augmentation or augmentation mastopexy with ADM in conjunction with standard techniques over a 6-year period between October 2005 and December 2011 were retrospectively reviewed. Only patients with at least 1 year of follow-up were included in the analysis. Results: A total of 197 revisions were performed (197 patients). Reasons for revision included CC (61.8%), implant malposition (31.2%), rippling (4.8%), ptosis (4.8%), implant exposure (1.6%), and breast wound (0.5%). The mean ± SD follow-up period was 3.1 ± 1.1 years (range, 0.1–6.1 years). The complication rate was 4.8%, including Baker grade III/IV CC (1.6%), infection (1.6%), implant malposition (0.5%), hematoma (0.5%), and seroma (0.5%). Most (98%) revisions were successful, with no recurrence of the presenting complaint. Conclusions: The use of ADM in conjunction with standard techniques for the reinforcement of weak tissue in revision augmentation and augmentation mastopexy patients appears to be effective. Level of Evidence: 4
    No preview · Article · Feb 2013 · Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery
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    ABSTRACT: : Although acellular dermal matrix materials have been in use for over a decade in primary and secondary breast reconstruction and in some cosmetic breast surgery, little has been published on the outcomes of these materials for cosmetic applications. : A retrospective institutional review board-approved review was conducted of all patients who had a specific acellular dermal matrix, Strattice, used for cosmetic breast surgery performed by the senior author (S.L.S.). Patient demographics, indications, surgical findings, and postoperative course were collected and data analyzed using descriptive statistical tools. : Between 2008 and 2012, Strattice was used in 43 cosmetic breast operations (75 breasts) performed by the senior author (S.L.S.). Sixty-nine of the 75 breasts (92 percent) were revision operations. Indications included inferior pole support [39 breasts (52 percent)], fold malpositions [28 breasts (37 percent)], capsular contracture [25 breasts (33 percent)], and rippling/palpability [six breasts (8 percent)]. Three patients (six breasts) had Strattice placed during primary augmentation/mastopexy. Seventy-four of the 75 breasts (98.7 percent) had successfully achieved the indication for which the Strattice was placed; one breast (1.2 percent) had some degree of relapse. The global complication rate for all patients in this study is 5.3 percent-two breasts (2.7 percent) had postoperative malposition, one breast (1.2 percent) had bottoming out, and one breast (1.2 percent) developed an infection that resulted in temporary device explantation. : The use of Strattice is safe and may be helpful in the management of certain situations in cosmetic breast surgery, including needed lower pole support, capsular contracture, rippling, and implant malposition. : Therapeutic, IV.
    No preview · Article · May 2013 · Plastic and Reconstructive Surgery
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    ABSTRACT: : Acellular Dermal Matrix (ADM) has been used for over a decade in primary breast reconstruction. Few have specifically examined the use of ADM in revision breast reconstruction for fold malposition, capsular contracture, rippling, and symmastia. One hundred thirty-five revision breast reconstructive procedures using AlloDerm© in 118 patients (154 breasts), over a 5-year period were reviewed. The majority of the procedures were revisions or part of the 2 stages of previous mastectomy reconstructions, while 3 were revisions after reconstructions of congenital chest wall deformities. Fifty-seven (37%) of the revisions were for inferior fold malposition, followed by 40 (25.9%) for inferior pole support, 42 (27.2%) for capsular contracture, 10 (6.4%) for rippling and 5 (3.2%) for symmastia. The overall complication rate was 5%. Revisions with ADM were successful in 147 out of 154 breasts (95.5%). The most common complication was capsular contracture, occurring in 5 breasts (3.2%). There was one infection (0.6%), failure to lower the IMF in one breast (0.6%), and one persistence of rippling (0.6%). The mean follow up was 207days. ADM has proven to be a reliable tool in managing some of the most common and challenging problems in implant-based breast reconstruction. While there is little published data on the success of more conventional solutions to fold malposition, lower pole support, and capsular contracture, the addition of ADM to buttress these repairs has been shown to provide a high likelihood of success with a low risk of complications.
    No preview · Article · Oct 2013 · Plastic and Reconstructive Surgery
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