I am 2 years post-op, seeking a breast augmentation revision. My current implants are 475cc, high profile saline, sub-muscular. I have consulted with many local surgeons, half of which suggest using Alloderm, and the others advise against it. In addition, I had about the same split advice when it came to whether or not I should get/need a lift. The results of my previous surgery have stretched my skin very thin and I develop very noticeable rippling on the sides of my breasts when I lean forward
Would You Recommend Alloderm for my Revision? (photo)
Doctor Answers (11)
Do you need Alloderm?
Alloderm has been used when tissue was deficient and to help camouflage implant issues such as rippling. If you were not averse to gel implants, gel implants are known to help diminish rippling. As for the thinned skin and large areola, mastopexies can be used to help improve the appearances of your breast but rather than employ Alloderm at the additional costs and risks of using it, my preference would be to overlap your inferior poles as part of the mastopexy, doubling the thickness of your inferior coverage and providing a longer lasting lift. This technique has worked very well in my patients with your current results.
Breast Revision Surgery
This is a great question and a difficult one to answer without an exam. From your breast pictures posted, I believe a smaller less projected implant should be utilized. Also, silicone gel implants would decrease the incidence of rippling. If your breast tissue is thin and inelastic at the lower portion of the breast, then an acellular dermis would be beneficial to prevent bottoming out in the future and to help with rippling. I agree with the previous surgeon's post, that Strattice, not Alloderm would be a good choice due to the non-stretch characteristics and the cost would be much cheaper.
Need to consider your size.
In my opinion, your current situation is the result of using an implant that was WAY too big for you in the first place. I truly hope part of your plan is to go smaller because if not, you'll be posting your pictures here again in a couple years asking about the next fix... In my hands, I would change to smaller silicone implants (to minimize the rippling) and do a lift (to get rid of some of the stretched-out skin and reduce the size of the areolae). I would not use an allograft. If you were one to refuse a lift and wanted to keep your saline implants, then the allograft would be useful (but I think that is a HUGE mistake). You had a very nice figure in your original pictures -- you should have a breast to match. I think that a nicely shaped C-cup would do you a world of good and probably get you through many years without another revision. Good luck!
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Use of ADM may not be the complete solution
Thanks for posting this important question. Use of acellular dermal matrix eg. Alloderm can be a useful adjunctive treatment for the correction of rippling. Probably the better answer is to reduce both the size and projection of the implants. The tissue thinning that you describe is the inevitable consequence of large highly projecting implants. Conversion to silicone gel implants would be another consideration.
Would You Recommend Alloderm for my Revision?
Thanks for the posted photos. Very hard to advise over the internet without an in person examination. I do recommend in your case acellular dermal matrix implantation with a possible lifting. But again best to obtain in person evaluations from boarded PSS in your city. Keep looking.
Breast implant revision without Alloderm
Alloderm and Breast Revision
Please refer to my response to your post from yesterday in addition to this one. To be sure, your implants have descended below the inframammary fold and out from under the subpectoral cover, but the usage of Alloderm, Srattice, or any other ADM might only be necessary if you made the (wrong) decision to stick with these large, high profile implants. The ADM would be used to reinforce the internal capsule's plication upon itself, known as a capsulorrhaphy. This is not the only way to reposition an implant, and another effective way is to recreate a new subpectoral space between the top of the current capsule and the muscle, allowing the capsule to collapse upon itself.
The other issue is your attenuated and over-expanded skin/tissue in the lower pole. The need for a lift can be determined in an objective (not opinion based) way by taking measurements of the distance from the nipple to where the new fold will be and comparing that distance to the size of the new implant's measurements. If the distance is greater, a lift is needed. If a lift is needed, then an anchor incision lift would remove the most injured tissue and give the prettiest shape.
I hope you can come to a quick resolution to this and get the results you had originally hoped for!
I would suggest a vertical breast lift and switch to smaller implants. also,you might want to consider switching to,silicone gel implants because they won't ripple as mcu and will feel more natural. Trying to stay with such large implants will,continue to create problems especially since your skin is so,thin.
Strattice for Support in Breast Revision
I agree with the surgeons who opted for a dermal matrix product for support and to diminish rippling but I prefer Strattice (porcine dermis) to Alloderm (human dermis) for this. (they both are made by the same company - Lifecell) The Strattice stretches less which is important in your case and also is significantly cheaper.