Breast Revision Using ADM (Acellular Dermal Matrix)? (photo)

Thank you very much for this thought provoking question.  I'm assuming your capsular contracture is on the left, although you did not state that.  I would agree with your second doctor that you need silicone implants and some form of lift.  Another piece of information that we would need to know in order to give you a complete answer would be, are your implants above or below the muscle.  If they are above the muscle, then pocket switching would certainly be useful.  ADM has been given very good ratings for decreasing the chance of capsular contracture in a recurrent situation; however, there are no guarantees on the subject.  From your comments, it would appear both of the plastic surgeons you consulted with recommended a lift, which I totally agree with.

One other modality that you have not mentioned would be the use of Accolate.  This should definitely decrease the chance of re-encapsulation, and I recommend that you use this prophylactically starting two days after surgery.  There have been many good papers on the subject and under these conditions, it would probably be an appropriate adjunct to your post-surgery game plan.

Hello! Thank you for your question!  Given your history as well as symmetry and shape issues, consideration for pocket revision 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.  It has been used safely and effectively to correct synmastia, restore the inframammary fold, mask implant issues (e.g., rippling, wrinkling, etc.), support the implant within a "sling", and improve aesthetic results in revisionary breast implant and reconstructive procedures.  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 who will assist you in deciding which procedure(s) will be the right for you.  Best wishes!  Hope that this helps!

Although difficult to give you an accurate recommendation without a proper examination, I would say that to address your capsular contracture is one thing, doing an implant revision is another.To address your capsular contracture, using an ADM is a new way to treat this problem and it may be successful. Another option is to reposition your implant into a new pocket (go from submuscular to subglandular or vice versa)Changing implants to a different profile or going from saline to silicone and moving your nipple is about changing the appearance of your breasts and it is unrelated to addressing your capsular contracture.

Acellular dermal matrix  has become popular as a way of dealing with implant encapsulation. I have no experience with it, but I have heard it is quite successful in preventing recurrent encapsulation.  There are some other considerations, however.  A lift with  new silicone implants and ADM is going to be  a pricey  undertaking.  Plastic surgeons seem to be a little overly anxious to jump on the ADM bandwagon, not knowing  what the long term implications are.  I would probably opt for a simple  capsuletomy and implant replacement.  A lift would be optional but not absolutely necessary.

Hello,

I believe you've posted before, no? I disaggree with both doctors.  High profile implants will give you a ballish look like a contracted implant, especially if your tissues are thin.  In addition, they cause more long term thinning of your tissues, and are more likely to drop down out of the cover of your muscle, kind of where your implants are now.  It is in vogue to use these implants because the companies push them, and surgeons are not aware of their long term effect.

ADMs are great devices and they have enabled reconstructive surgeons to perform one stage breast reconstruction with incredible beauty and a natural appearance.  There has been a transfer over to the cosmetic usage of ADMS with reinforcing breast implant capsules for support and to minimize rippling.  There is most recently talk of using them for recalcitrant capsular contracture.  My feelings are that they are unnecessary and overly expensive (more than a pair of silicone gel implants).  Adhering to the principles of placing a new, properly sized, moderate profile implant in the submuscular position after a true total capsulectomy will likely halt recurrent capsular contracture most of the time.  The addition of a leukotriene inhibitor like Singulair or Accolate might be considered.  However, Accolate exposes you to a small but real risk of liver toxicity, so I only use Singulair.

Looking at your photo shows that your implants are in a low position and have dropped into the sagging portion of your breast.  Removal of your implants with the entire capsule, replacement with new, moderate profiled implants with a 'no touch' technique, followed by a formal mastopexy will produce a result that will look pretty and will likely not recontract.

Best of luck!