Recurrent Capsular Contracture and Alloderm or Strattice ADM products
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 sitll 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.
Plastic & Reconstructive Surgery:
December 2010 - Volume 126 - Issue 6 - pp 1842-1847
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.
Stattice or Alloderm for recurrent capsular contracture
With your history of several breast surgeries and recurrent capsular contracture. The Acellular Dermal Matrix, (ADM), products may be a good fit. This dermal matrix is made from dermis, (a layer of skin). Alloderm is made from humans. Strattice is made from porcine, (pig) skin. We have used this type of material in the burn unit for a while. It is also being used for breast reconstruction, and not in breast revisional surgery. When used in the breast, both usually require drains as there is an increased risk of seroma.
In good hands the results have been impressive. There is a significantly decreased amount of capsular contracture.
I would seek out a board certified plastic surgeon with significant experience with the product. Hopefully this can work out for you.
Capsular Contracture Recurrence
This is a tough problem. I would wager to say that every physician who places implants has seen and battled capsular contracture. By now, you may know that one accepted cause is a low grade peri-implant infection. The route of implant placement may affect this. The nipple is colonized with bacteria chronically. Thus, it is generally accepted that placing an implant through the areola may raise the risk of CC. Additionally, any minor bleeding around the implant may lead to CC. Some plastic surgeons (myself included) bathe implants and the breast pocket in triple antibiotic solution. Additionally, post operative oral antibiotics are the norm. I ask that my patients begin implant displacement exercises 2-3 days after surgery. Moving the implant, some believe may avoid capsular contracture. Additionally, Accolate may help to modify the inflammatory response and avoid capsular contracture. This med is associated with a low risk of liver problems. Thus, it is sometimes wise to replace it with Singular. Good Luck!
Strattice use after capsular contracture
The etiology of capsular contracture is not entirely clear, and so options for treatment and prevention are somewhat lacking. A previous history of capsular contracture does increase your risk of subsequent contracture. Strattice may provide some benefit but it will not guarantee you will not develop another contracture. The asthma medication Zafirlukast (Accolate) may also help prevent capsular contracture if you decide to replace the implants.
Strattice to Lessen Chances of Capsular Contracture?
Sorry to hear about the complications you have experienced. Capsular contraction can be a very frustrating complication for both patients and surgeons. In my practice, I have found the most success treating these difficult problems utilizing techniques such as sub muscular pocket conversion (if relevant), capsulectomy, use of fresh implants, and the use of acellular dermal matrix.
Acellular dermal matrix is a biologic implant that carries the ability to become integrated into native tissue. It is made by taking a full thickness section of skin from a donor source (his human, porcine, or bovine in origin). I hope this, and the attached link ( demonstrating a case utilizing acellular dermal matrix) helps.
Use of Strattice during capsulectomy to decrease chances of recurrence breast implant capsular contracture
For recurrent breast capsules, there have been many recent reports recommending the use of Strattice or Alloderm. Though not completely conclusive, these reports are very promising. As you know, there are many known and unknown causes of breast capsule contracture. Breast capsule contractures are thought to be caused by numerous causes. These include infection, blood in the capsule, type of implant, and position of the implant. It is thought that use of antibiotics during surgery and after surgery can decreases the chances of breast implant capsules. In addition, implant displacement exercises are thought to decrease the incidence of breast capsule formation.
I would certainly use Strattice or Alloderm. You have had a significant number of surgeries and I do not see any contraindication to using Strattice. Often, breast capsulectomies and insertion of Strattice are a covered medical benefit. Please consult with your board-certified plastic surgeon regarding insurance coverage for this procedure.
Strattice reduces chance of recurrent capsular contracture
Strattice has been extremely effective at preventing capsular contracture and is the "go-to" option for recurrent cases. It is important to also remove the scar capsule (capsulectomy) and replace the implant.
Recurrentl capsular contracture treatment options with ADM
The data on ADM (acellular dermal matrix) with Alloderm being the most popular but most costly is mixed. Currently it seems to be effective. Other substitutes such as Strattice as well as numerous other products claim to get the same results. A Neopectoral pocket with new implant is other alternative.
Strattice for Capsular Contracture
Although I have no personal experience with Strattice, after discussions with colleagues and the company, I feel it is an excellent procedure as a salvage for recurrent capsular contracture. The procedure can get costly, but it is probably worth it after all you have been through, and to avoid explantation. I would definitely consider it.
Capsular Contracture Treatment
As you are experiencing, established cc's are very difficult to treat. Strattice is processed cadaver dermis and it has been shown to decrease recurrence. Problem with it is it is expensive, and increases risks of infection. It is a bit tricky to work with, so there is a learning curve.
All that said, your choices include the Strattice plan, leave things alone, remove the implant and capsule and allow to heal, replace in about 6 months. Any may be reasonable. I might consider the removal, healing, replacement in ~ 6 months. If that failed, I would consider removal and leaving them out.
Also, ask your surgeon about Vitimin E, and Accolate treatments, along with prolonged antibiotic coverage if another implant is placed.