I have an encapsulation after 11 ys of having implants. I've been to see a few doctors and 2 out of 3 docs have said that I need to replace my saline implants with silicone, I need a full lift and because my skin is so thin, I need either strattice or ADM. One PS wants to charge me $2,000 for ADM and the other $4,000 for strattice. I thought that the ADM cost more? I'm confused and don't know what to do. My implant is twisted and is poking against the skin above my nipple. Any suggestions please? TY!
ADM Vs Strattice. Need a Second Opinion? (photo)
Doctor Answers (9)
Barking up the wrong tree...
This is of course speculation without an examination, but your implants are on top of the muscle. You don't appear to have capsular contracture. Even if you do, the solution is the same. You can see and feel the implant because the breast tissue has thinned over the front of the implant (maybe you've had children or it is just the result of the implant being there for 11yrs). This is precisely why many of us put the implant under the muscle. The use of ADM or Strattice is just trying to add something "thicker" over the implant without putting it under the muscle. Changing to silicone implants has little to do with it (although I think that's a good choice). Will this happen again in 5-10yrs with ADM? -- no body knows because we haven't been using it for that long for this reason. Putting it under the muscle is permanent. There are many ways to go about that -- personally, I would do it in a single stage, removing the saline implant, placing a new submuscular implant, and doing a vertical lift. I use ADM in many situations, but I don't feel it's needed in this case. Save the $4000, do the right surgery, and you won't have to spend $10,000 to fix it again in 10 years! Good luck!
Breast capsule instead of ADM
Your photographs show your implants have descended and are no longer under the pectoralis major muscle. I recommend you undergo implant removal or placement of implants retro-pectorally and a lift done at the same time. The lift should not involve a vertical scar such as a boat anchor or lollipop incision but can be done through a circumareola approach. You appear to be an excellent candidate for a new technique called Breast Augmentation with Mini Ultimate Lift. Also, you will not require ADM. The capsule from your implant can be used to reinforce the placement of the implants retro-pectorally.
Gary Horndeski, M.D.
Your case is difficult to evaluate without being able to examine you in person. As you have found out, there are as many different opinions out there as there are plastic surgeons. First of all, I'm not convinced that you have capsular contracture. Many patients with saline implants and thin skin experience rippling of the implants which gives them an undesirable feel and some patients confuse this with encapsulation. saline implants have a very low incidence of encapsulation compared to silicone gel, so you may not truly have encapsulation. Perhaps switching them for silicone with a lift would be an options for you. as far as ADM is concerned, I would reserve its use for patients with RECURRENT encapsulation. First of all, as you have found out, it is very expensive and might not even be needed in your case. Although many plastic surgeons are enthusiastic about its use, ADM hasn't been used for that long and we don't know what will happen to this stuff in 5 or 10 years. I am reluctant to jump on the ADM bandwagon, and would try another approach first. Good luck!
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Strattice is an ADM for breast implant revision surgery
ADM's are Acellular Dermal Matrix products meaning that they are made from skin with all of the cells removed. This leaves only the collagen matrix which acts as a template for your own cells to move in and transform the matrix into living tissue. Strattice is an ADM made from porcine tissue, and is most xommonly used for revisions of cosmetic breast implant surgery. Clinical experience has shown that Strattice is very effective at preventing recurrence of capsular contracture and providing additional coverage and support. Alloderm is more commonly used in reconstructive surgery.
Capsular Contracture and ADM
I believe you posted before, so I wont reiterate all that I said then, but I want to tell you a few things now that I believe should influence your decision making process.
The term ADM, or acellular dermal matrix, is a term used to describe many products available, including Strattice. Lifecell Corporation makes Alloderm (human origin) and Strattice (porcine origin). These products are the first of their kind, and are the most commonly used. Alloderm is more expensive than Strattice, but wouldn't cost $4000. Strattice has specific shapes and sizes, and there is one designed for use in breast implant pockets; it costs $1850 for a pair.
Like high profile implants, ADMs have been heavily pushed to the plastic surgeon as a product that 'you just can't live without'. When it comes to capsular contracture, there are very clear principles of surgical treatment that get ignored or simply not followed by the plastic surgeon because it is frequently difficult to perform. One of those principles is the complete removal of all capsular material in one piece from the implant pocket, called a total capsulectomy. Performed correctly, and in conjunction with replacing a new implant, it rarely leads to recurrent contracture, even in those that have had one or two previous capsular contracture surgeries.
You don't have a twisted implant. What you feel is a 'knuckle' from a fold in the shell, usually caused by capsular contracture squeezing the implant into a confined space. This knuckle is firm and doesn't give, so it can cause significant thinning of the tissues directly above it, however that doesn't warrant the need for an ADM either.
A total capsulectomy, replacement with silicone gel implants, and a full mastopexy sounds like a reasonable plan that will reproducibly provide you with a long lasting, pretty result. Your decision to use an ADM has really no evidence to suggest it will make your result better, or decrease your risk of capsular contracure (I've seen capsular contracure occur with this product in someone who didn't have it in the first place).
Best of luck!
ADM Vs Strattice. Need a Second Opinion?
Totally agree with using a product but as cost seek more in person consults to see a range in the fees of these products. Moat have a cost of apps. $2,000+/-
Need for second opinion
The strattice vs adm has been well explained previously. The surgical plan is not as clear cut. You have several options.
change to silicone gel is your choice based on how you want your breasts to feel
type of lift could be either periareolar or vertical...again based on your goal appearance.
use of strattice...seems to lower the chance of capsule contracture recurrence, but may not be necessary if you are willing to take the chance of higher recurrence.
Get another opinion from a surgeon who does all these to provide you with the pros and cons of each.
ADM for use in #breast #revision
It sounds like your plan in general is what I would expect for a revision surgery, but there are some issues confusing your understanding. An ADM is an acelluar dermal matrix that comes in the form of different manufacturers that have different qualities. Strattice is just one of those. The price does range from $2-4K and this could easily represent the actual cost. Otherwise you need to understand why each surgeon uses their particular product as there are individual preferences and these products are not all equal.
Best of luck,
Vincent Marin, MD
San Diego Plastic Surgeon
ADM Vs Strattice
There is a semantic problem here. ADM stands for acellular dermal matrix. It is a biological
product. Strattice is one of several ADM's on the market. It seems to be by far the most commonly used among the ADM's for revisional breast surgery. The other advantage of using Strattice in addition to providing better cover is that the chances of a recurrent contracture is diminished.
It looks like you got good advice. By all means consider another opinion--but know that it may clarify or confuse you further!
Thanks for the question, and best wishes.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.