I have silicone implants which are 32 years old. I need surgery for encapulation in both breasts. One doctor has recommended insertion of "pig lining" material but another has said this is only necessary in the event of a tear. Please explain this "extra" procedure and when necessary.
When Are "Pig Skin" Linings Necessary After Encapsulation Surgery ?
Doctor Answers 8
Alloderm or pig skin?
Alloderm ( which is from humans) and variations of treated pig skin are used for lining in situations where better coverage is needed for the implant such as in cases of rippling. It is also used sometimes to reinforce the fold and also in breast recosntruction.
Pig, cow or human skin for capsular contracture from breast implants
The use of the pig skin lining is actually more related to recent reports of cadaveric skin (called acellular dermal matrix, commonly known as Alloderm) that has been shown to lower the risk of recurrent capsular contracture. The mechanism for this is unkown. I think that you could get by with a simple implant removal and capsulectomy. Alternatively, I have had much success with a neopectpral pocket.
Implant coverage and support with "pig skin"
I often use Surgimend ("cow skin") when I do implant revisions for significant capsular contractures in women with thin skin and only a small amount of breast tissue. Strattice ("pig skin") and Alloderm ("human skin") are also used for the same purpose. They are helpful tools during tough revisions, such as yours.
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Treatment of Capsular Contracture
Breast implants that are long-standing and encapsulated typically require complete capsulectomy and implant removal and replacement. If your overlying tissues are already quite thin, and you take out the scar layer around the implant, you are thinning your tissues even more. In the setting of thinness, the implant can be more visible, prone to rippling, and skin sagging can sometimes be an issue. Treatment options for me usually start with pocket site change to submuscular if it isn't already, with or without skin tightening procedures such as breast lifting. In patients with recurrent contractures and history of multiple surgeries, when options for local tissue coverage have been exhausted, then the addition of Alloderm (human skin) or Strattice (pig skin) may be necessary to provide coverage over your implant and reduce implant visibility.
Old implants, encapsulation and pig skin
You implants are really old and surely ruptured. That generation of implants had very thin and weak shells and rupture is common. The rupture likely caused inflammation, the inflammation lead to excess scarring which we call capsular contracture.
I would recommend having your old implants out along with the capsule and have new implants placed. I wouldn't recommend pig skin unless your tissues are super, super thin. In that case, I would remove your implants and capsules, let things heal and settle down for a few months and then start over with new implants and maybe pig skin.
Pig skin and other dermal products may possiblly decrease the incidence of recurrent capsular contracture of uncertain cause, meaning that there is no obvious reason for the capsule. But in your case, with such old implants, a rupture and capsular contracture are expected.
These dermal products are very, very expensive and are being heavily marketed to Plastic Surgeons. They work well when needed but most patients don't need them.
My humble opinion.
Lisa Lynn Sowder, M.D.
Sometimes Implant Needs Additional Support
Soemtimes, when the implants have been in for many years and they have become completely encapsulated, it is necessary to remove all of the old scar tissue and implant material. What can happen sometimes is that the new implant does not have enough tissue to support it because they have been weakened by removing the old capsule. In those cases, it is nice to support theimplant with some sort of biological material that your body will incorporate into its own over the course of 6-8 weeks. There are a number of different types, but they are all based on dermis from either humans or some type of animal ( porcine, bovine, etc.). I hope this helps.
The use of "Pig Skin" in Correcting Breast Implant Scarring (Capsular Contracture)
Strattice for revisional breast surgery
The 'pig skin' product that you are referring to is Strattice, which is a porcine derived acellular dermal matrix product. It can be used for a variety of revisionary breast surgery applications. It is not necessary, and I don't even think there is solid clinical data to support the necessity of using Strattice after capsulectomy to prevent recurrent capsular contracture.
Where Strattice is enormously helpful is for patients with implant malposition and soft tissue coverage issues. Seek out a board certified plastic surgeon with some experience using Strattice for an expert opinion.