New techniques for revision breast augmentation surgery

I have written several posts about  complicated breast augmentation surgery with saline or silicone implants and its possible sequelae.

Breast augmentation implant capsule treatment

Breast implant capsule formation

Every so often, something does go wrong in breast augmentation surgery for some reason! The causes are rarely anyone’s fault. These things just happen, and neither cosmetic plastic surgeons nor breast augmentation patients can predict or prevent these rare occurrences.

 Complications of breast enlargement

Some of the complications of breast enlargement surgery include:

  • Infection
  • Bleeding
  • Implant malposition
  • Capsular contracture
  • large cell anaplastic Lymphoma (v. rare)

Infection and bleeding tend to occur in about 2% of breast augmentation surgeries and usually require breast implants to be removed and replaced after a few months. Both these complications can lead to another: capsular contracture or hardening of scar tissue around breasts.

New products for treatment of breast augmentation complications:

Strattice and Alloderm

Alloderm graft alloderm for reconstruction

When a complication occurs after cosmetic or reconstructive breast surgery, there is usually a deficit of tissue or lack of support for the breast implant.

 Strattice, Alloderm and other similar new materials are now available to help with these situations.

These materials are derived from human or porcine (pig) skin which has been treated  in a way to remove cells and leave only a dermal skin architecture.

Once placed in our bodies, our cells will creep in over the architecture and populate the area.

The materials can provide for extra:

  • thickness where the skin in thin
  • strength where it is weak
  • support where it is needed

These dermal substitutes in effect allow cosmetic plastic surgeons to better control the shape and size of a breast implant pocket when it has:

  • become too large and stretched
  • developed a capsular contracture (the materials prevent capsular contracture formation)
  • implant malposition
  • rippling of the implant

Strattice- and Alloderm-like materials come prepackaged. Some need to be re-hydrated and others are ready to use.

The materials come in different sizes and typically are about 15 cm  long and 5 cm wide. They are usually sutured into place using absorbable sutures. The most common placement is like a hammock under the breast to provide support and keep the breast up, much like a half-cup bra on the inside of your body! The cost of a small piece is about $2,800! Expensive!

The surgery with these dermal substrates adds a little more time, but the healing and recovery are not really affected.

There is a slight increase in seroma (fluid accumulation) formation with the use of dermal substitutes.

Larger pieces of the materials have been used for abdominal wound coverage. In the past there were few options for correction of the type of complications that can occur after breast augmentation. The new materials provide an opportunity for the cosmetic plastic surgeon to better control surgical results after revision breast surgery.

Every so often a new modality comes to market to treat capsular contracture. The latest is an external ultrasound that purports great results. I have no experience with it but if it really does work it would be great. If…..

Morad Tavallali, M.D., FACS