Third Breast Implant Revision Surgery, Time for Strattice? (photo)

1st surgery was 4 yrs ago and I bottomed out w/125cc. Decided on revision and went with a well known revision specialist who did an internal bra instead of using strattice..he also increased implant size. Results were less than desirable with uneveness and asymmetry. Had 2nd revision apx yr ago. Pic posted..can feel implant w/rippling underneath the skin is so thin. I feel my only option is revision w/strattice in order to attain better results. How do I find a Dr. that routinely uses it?

Doctor Answers (8)

Time for Strattice?

+3

With your history and description of the thinning out of your tissues, I think it may very well be time for Strattice.  Strattice will give some extra padding to the thin areas and allow your surgeon to better control the implant pocket.  The downside is its expense and the added OR time.  Talk to the revision specialist about this.  He/she may be comfortable with Strattice or may be able to refer to someone who has some experience. 

Also, don't feel you have to go to someone who has done a bazillion cases with Strattice.  I think an experienced plastic surgeon who does a lot of implant cases and who has taken a course and done a cadaver lab with Strattice, is qualified to do a case like this.  All of us have a "first time" with any new techniques or materials.  My first few Strattice cases all went very wellt but I was very, very glad I had had very good training with its use.

 


Seattle Plastic Surgeon
5.0 out of 5 stars 46 reviews

Strattice and it's benefits for breast augmentation.

+3

Strattice is a pig skin acellar dermal matrix. It is effectively a biologic mesh. The advantages of Strattice include improved tissue thickening, correction of implant malposition (bottoming out), reduction in the appearance of implant rippling, and reduction in the likelihood of capsular contracture. I do use Strattice and other dermal matrices routinely. A good option is to call around to board certified plastic surgeons in your area to find out who is using this for revision breast surgeries.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 12 reviews

Third breast implant revision surgery - time for mesh or matrix?

+1
Hello! Thank you for your question!  Given your history of failed attempts at revision to correct symmetry and shape issues, consideration for either an acellular dermal matrix or mesh-type substitute is reasonable.  .  A capsulorrhaphy would be needed for revision of your breast pocket. If you do need such, the use of a dermal matrix or mesh may be considered if your tissue now has significant laxity that is failing in support or a significant deformity in which recreation of the breast pocket is required along with adding additional support and coverage of the implant.  Certainly, the larger the implant, the heavier the weight...thus, it may be useful to consider placement of a matrix or mesh. Otherwise, capsulorrhaphy for pocket revision using your native tissue should suffice. However, only by physical examination would one be able to make recommendations on the benefits over the risk of using a matrix or mesh in your situation. 

Consult with a plastic surgeon well-versed in breast procedures and the use of dermal matrices and mesh in breast procedures who will assist you in determining which procedure(s) would be the best for you. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

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Strattice internal bra for revision surgery

+1
For a third revision, it is very important to have a plan with a high probability of success because each operation makes subsequent ones more difficult. Strattice often addresses the multiple problems that can occur. I am not sure what the internal bra procedure you had was, but I would use the term to describe how Strattice or newer materials such as SERI scaffold are used. For doctors in your area familiar with Strattice, please see the link below.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 28 reviews

Avoid Stratice! Your own body has a much better structure: Fascia intelligent use of the subfascial plane is the answer

+1

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.

Rian A. Maercks, MD
Miami Plastic Surgeon
5.0 out of 5 stars 36 reviews

Strattice for implant support (correction of bottoming)

+1

As you have detailed, you have complex breast surgery history.  And you highlight some challenges to your case including very thin skin.   So, I would need to examine you to make any recommendations.  If indeed your problem is implant bottoming, I do have extensive experience with strattice and revisional breast implant surgery.   I am convinced that strattice xenograft is an excellent option to correct implant bottoming out.  However, in addition to the strattice intervention, you may need additional procedures to restore balance/symmetry and achieve your goals.   Please visit with a board certified plastic surgeon to learn more about your options.  Best of luck.

 

Dr. Basu

Houston, TX

 

 

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 124 reviews

Revisionary Breast Augmentation Surgery with Strattice

+1

Thank you for your question and photos.

I would need to examine you in person to determine what the best course of action would be for your case.

Although capsulorrhaphy +/- the use of Strattice could be an option, another option may be a formal breast lift.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 780 reviews

Breast revision surgery

+1

Strattice is used to support the implant and also to camouflage against rippling.  To determine what would be best for you, a complete exam is essential.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

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.