Recently had breast aug; strattice was used to treat encapsulation and prevent reoccurance. I've read it takes several months for the strattice to integrate; how can strattice prevent early encapsulation that occurs before the material has integrated? Previously I developed cc immediately post op within few weeks of surgery.
Integration of Strattice to Prevent Encapsulation
Doctor Answers (7)
Strattice and treatment of breast capsular contracture recurrence
You are correct that acellular dermal matrix grafts such as Strattice, Allomax, etc. can take several months to be completely incorporated into the body. However, even prior to this incorporation it appears that the dermal matrix graft acts as a scaffold for one's own fibroblasts and subsequent collagen formation to grow upon. By providing this early structure, Strattice may inhibit the contraction of the actin and myocin fibrils found in the scar capsule. Although no treatment can guarantee a prevention of capsular contracture, I too have seen good results with acellular dermal matrix grafts.
Strattice and capsular contracture prevention.
The theory on why capsular contracture is prevented with Strattice (as well as Alloderm) is due to the lack of capsule formation in the area where the Strattice abuts the implant.
The capsule around the implant is a cellular response to the foreign body. This is in part an inflammatory response for which the body identifies the implant as "foreign" and attempts to isolate it from your body. Certain triggers (infection, bleeding, etc.) can prolong this inflammatory response leading to thicker capsule formation. This capsule is essentially a dynamic scar. As with all scars, a degree of contracture occurs. The degree of contracture varies greatly between individuals. In some cases of capsular contracture, the circumferential capsule can squeeze to the point of implant elevation, firmness, even pain.
Strattice is a dermal matrix - essentially collagen and elastin proteins without any actual cells. When Strattice is used, only the protein matrix abuts the implant. Without any cells present to produce a capsule, a capsule does not form where the Strattice is present. Even though vascular and eventual cellular integration occurs within the Strattice, it does not appear to have the same robust inflammatory response. Why this does not seem to occur is under study. Regardless, one theory is that without a circumferential capsule around the implant, the effect of contraction upon the implant (particularly the typical "elevation" of the implant) does not seem to occur. Thus, capsular contracture appears to be held in check by the use of dermal matrices such as Strattice and Alloderm.
Strattice has become a very good tool for plastic surgeons doing breast reconstructive surgery. We have noticed that Strattice used in breast reconstruction after mastectomy had an extremely low incidence of capsule contracture. It is not understood why this is. There is work being doine on this as we speak. Hopefully Strattice will give us better results. Stay tuned.
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Strattice and CC
that is the million dollar question but fortunately, it seems to work with early evidence showing great promise. I suspect it will become more common in primary breast augmentation as the price comes down and evidence gets stronger. good luck
Capsule prevention with Strattice
I agree with Drs Greenwald and Baxter on this. The mechanism for prevention of capsular contracture with Strattice is not really known - but it appears to work!!!! All of my patients with previous capsular contracture treated with total capsulectomy and Strattice so far have had no recurrence of contracture.
Strattice and breast capsule tightening after augmentation
Although the mechanism has not been completely determined it is clear that biologic materials inhibit the contraction of the periprosthetic capsule that can occur after breast augmentation. The leading theory is that the biologic membrane provides a collagen scaffold that is resistant to contractile forces.
Although complete incorporation can take several months, biologic membranes that are properly stabilized begin to experience vascular ingrowth within 2 weeks. It is this ingrowth that makes these membranes resistant to infection and allows for ultimate complete replacement with your own tissue.
It is likely that with the addition of Strattice you will not experience significant contraction. If encapsulation with contracture recurs it may be due to failure of the strattice to incorporate.
Time for Strattice incorporation for capsular contracture
Although the Strattice acellular dermal matrix graft can take some time to incorporate (transform into living tissue) it seems to be able to prevent a dense capsule from forming on the surface against the breast implant. Incorporation is necessary for long-term stability but apparently not for prevention of early capsular contracture. I have had very good success with it and wish you the best.