I had a ba in 2001 with smooth, saline, over the muscle and developed bilateral cc, worse on right side, within a few months. In 2003 I went to a new ps, I changed to a smaller implants, smooth saline, under the muscle, ps used drains, and I developed cc again in the right side with in a few weeks. In 2005 I removed the implants. I have been reading about the use of strattice for recurrent cc. I was quoted $3K for the strattice. What kind of results have you had with using strattice for cc?
Strattice Worth $3,000 for Recurrent Capsular Contracture
Doctor Answers (10)
Avoid Stratice! Your own body has a much better structure: Fascia intelligent use of the subfascial plane is the answer
The problems that lead to suggested use of Stratice and dermal fillers are way too common. The reality of breast augmentation is that most women have similar results and are simply not aware that there is a better option. The most commonlyt used technique is the "dual-plane" subpectoral placement. this sets up the implants for lateral and inferior malposition. The top of the breast has muscular coverage and because of the pectoralis major's origination next to the sternum, the implants are pushed away from midline creating the valley between them that you dislike ( I call this the Miami Valley based on the common augmented look of breast augmentations in Miami). Because the inferior portion of the breast is subglandular, there is no support and the implant tend to migrate toward the armpits then down.
For these reasons I do not perform submuscular or dual-plane breast augmentations. I use a technique that I call "Cold-Subfascial Breast AugmentationTM" that overcomes the shortcomings of dual plane. By leaving the muscle alone and precisely lifting the strong pectoralis fascia, I am able to custom design what is essentially a living natural brassiere to support the implant within the breast. Using this technique I am able to create beautiful natural appearing breasts that complement the individual patient's body.
I commonly revise patients in your position by converting them to the cold-subfascial plane. In my experience this is the only way to repair the breast and create a long-lived beautiful result. Artificial materials such as stratice are just asking for trouble in my opinion. I hope this helps!
All the best,
Rian A. Maercks M.D.
Treatment for Recurrent Capsular Contracture
Since you have been experience recurrent bouts of capsular contracture, you may benefit a procedure incorporating AlloDerm or Strattice dermal matrix products. There is emerging data showing that these products may have a role in slowing down or preventing capsular contracture. In fact, I published a clinical paper on this very topic in December 2010 issue of our primary plastic surgery journal: Plastic and Reconstructive Surgery. However, even as an primary author of this study, it is still to premature to guarantee that ADMs prevent capsular contracture. But there is growing evidence support this claim. In addition, several of my colleagues have stated other non AlloDerm or Strattice products do the same thing. There is absolutely no published evidence whatsoever to support this to date. Hope this helps.
Basu Plastic Surgery - Houston, TX
Plastic & Reconstructive Surgery: December 2010 - Volume 126 - Issue 6 - pp 1842-1847 doi: 10.1097/PRS.0b013e3181f44674 Breast: Original Articles Acellular Cadaveric Dermis Decreases the Inflammatory Response in Capsule Formation in Reconstructive Breast Surgery Basu, C. Bob M.D., M.P.H.; Leong, Mimi M.D., M.S.; Hicks, M. John M.D., Ph.D.
AbstractBackground: Acellular cadaveric dermis in implant-based breast reconstruction provides an alternative to total submuscular placement. To date, there has been no detailed in vivo human analysis of the histopathologic sequelae of acellular cadaveric dermis in implant-based breast reconstruction. Based on clinical observations, we hypothesize that acellular cadaveric dermis decreases the inflammatory response and foreign body reaction normally seen around breast implants.
Methods: Twenty patients underwent tissue expander reconstruction using the “dual-plane” acellular cadaveric dermis technique (AlloDerm). During implant exchange, intraoperative biopsy specimens were obtained of (1) biointegrated acellular cadaveric dermis and (2) native subpectoral capsule (internal control). Histopathologic analysis was performed. Masked biopsy specimens were scored semiquantitatively by an experienced histopathologist to reflect observed granulation tissue formation, vessel proliferation, chronic inflammatory changes, capsule fibrosis, fibroblast cellularity, and foreign body giant cell inflammatory reaction. Scores were analyzed statistically using the Wilcoxon signed rank test.
Results: Acellular cadaveric dermis (AlloDerm) had statistically diminished levels for all parameters compared with corresponding native breast capsules (p < 0.001).
Conclusions: This represents the first detailed histopathologic comparative analysis between biointegrated acellular cadaveric dermis and native capsules in implant-based breast reconstruction. These histopathologic findings suggest that certain properties intrinsic to acellular cadaveric dermis may limit capsule formation by diminishing inflammatory changes that initiate capsule formation. Further investigation is needed to determine whether acellular cadaveric dermis reduces the incidence of breast capsular contracture.
Capsular Contacture Rates with Strattice
Recents studies show a trend towards reduced rates of capsular contracture with the use of alloderm. Similar thought process has been applied to strattice. If you are considering replacement of your implants for elective cosmetic reasons, I would strongly consider the risk of recurrent contracture. If you desire to proceed with re-augmentation, it is important to understand that there is no proven method to prevent recurrent contracture and further complications.
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Strattice to prevent capsular contracture
I have used Strattice a few times for recurrent capsular contracture, and it has been effective with more than a year follow-up. Since your contracture recurred early, i think it is a very good idea. It is unfortunately quite expensive but it is a unique product.
Capsular contracture years after breast augmentation
All breast implants develop capsules shortly after they are placed. The question is what type of capsule will it be. That cannot be predicted before your body makes it. The capsules can be paper thin, a centimeter or two thick, contain muscle contracting like cells etc. Although Alloderm or other acellular dermal matrixes(ADM) may prevent the formation of bad contracting capsules I cannot logically see why that would be the case and to my knowledge that is have never been proven. ADMs are mostly used to reconstructed inframammary folds, treat symmastia or increase tissue coverage to hide rippling.
Yes, products like strattice or Alloderm seem to reduce the rate of capsules at least early on in the research, bu tno long term data is available yet.
Recurrent Capsular Contracture
Great question hard to answer. In Boca Dr Jason Posner is the PS wirth the most experience. Call him. From MIAMI Dr. Darryl j. Blinski
Recurrent capsular contracture: acellular dermis versus fat grafting.
Recurrent capsular contracture treatment with acellular dermal matrix is confusing due to the proliferation of biologic materials available. For example, some insist that Alloderm is superior to Strattice. You may want to skip the implants altogether and consider fat grafting for smaller sized augmentations in th erange of 250cc.
Recurrent Capsular Contracture
Recurrent capsular contracture can be a very troublesome issue, as you have found out. When this happens, many Plastic Surgeons (such as myself) will change out the implants (to address a possible bio-film), and then place a sheet of acellular dermal matrix such as Strattice between the implant and the scar capsule, and revising the capsule itself.
While there are certainly no guarantees with this approach, most of us do find that our success rates may improve over simply changing out implants.
I hope that helps!
Polyurethane covered implants do prevent recurrent capsular contracture
although they aren't available on the US market anymore, silicone gel implants with a cover of polyurethane have a well-known and proven protective effect against capsular contracture, primary as well as recurrent. This, and the long-term safety of these implants has been confirmed by American surgeons who have used these implants for years before they were taken off the US market.
We have been using these implants for over 10 years with great satisfaction. They are available in most European countries and in some Latin American countries.