Evil recurring capsular contracture from hell. Does ADM help with bottomed out breast implants?

I've gotten my breasts done twice, and one of my boobs has the same hard stubborn dent (scar tissue) that won't go away! My 2nd pair is textured/silicone, so that's no help itself. Out of 5 doctors I've seen for a consult, 2 recommend ADM. I'm wondering why others haven't suggested that. Does ADM also help with bottomed out breast implants?

Doctor Answers 8

CC

The two breasts commonly heal quite differently. One breast may swell more, feel more uncomfortable, or have a different initial shape. After complete healing, they will be more similar and natural. You must have patience, but if this causes concern, ask questions of the doctor or the nursing staff.

The final results are mostly present including "dropping of the implant" when implants are below the muscle within the first 3 months for most and certainly by a year. Breast implants initially after surgery when placed in a submuscular position often give superior fullness that corrects itself with time, the "fluff and drop" phenomena. In reality the pectoralis major muscle takes a while to adjust its size to accommodate the implant as well as occasional muscle spasm which keeps the implant projection higher than its final resting shape. As the muscle relaxes the projection of the implant often increases and the breast shape improves. Massage and use of a superior placed elastic strap can often make this process go faster.

Contracture

ADM are good for capsular contracture and do help. The other factors are the breast implant size and native tissue thickness. It can be hard to treat

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 14 reviews

Capsular contracture treatment

I'm so sorry you are dealing with a capsular contracture, they certainly can be frustrating.  ADM absolutely can help reduce your risk of recurrence.  It is important to see a board certified plastic surgeon who is comfortable with the treatment of capsular contracture.  It is important to address all potential causes (biofilm/rupture), remove the entire capsule, and alter implant type/size and incision location if needed.  The "dent" you describe can be addressed with fat grafting as well.  Good luck!

Kelly Killeen, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 6 reviews

ADM

I often do not go right to ADM for a CC because it is expensive to the patient.  But, yes, it can help reinforce the repair for a bottoming out.  I use ADM all the time for breast reconstructions.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

ADM (Strattice) is effective for both capsular contracture and bottoming out

In my experience Strattice has been very effective at preventing recurrence of capsular contracture. When treating CC, typically the scar capsule is removed (capsulectomy) and a new implant placed. The capsulectomy removes some of the support and coverage for the implant so the Strattice also addresses that issue by replacing the tissue. Although expensive, it is much cheaper than another surgery. 

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 46 reviews

Evil recurring capsular contracture from hell. Does ADM help with bottomed out breast implants?

I am 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.  Yes, this material may also be helpful in certain cases of breast implant displacement, including bottoming out situations.

In regards to the success of the revisionary breast surgery, careful selection of your plastic surgeon will be the most important decision you make. I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.
Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery.
***Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.
 
I hope this, and the attached link/video, helps.

ADM for capsular contracture

In my experience, the use of an  acellular dermal matrix like Strattice, has been very useful for patients who both have bottomed out breasts and recurrent  Capsular Contracture. Strattice is a purified form of pigskin that becomes integrated with your body's own cells over a month or two. Thus far in my practice, I have not seen capsules return when a fair amount of the capsule is replaced by Strattice. The downside is the Strattice costs which range between $4000 and $8000. Try to find a board-certified plastic surgeon with demonstrated knowledge and expertise in revision of breast surgery using  ADMs. best of luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

Expense and limited data

The reason is hat ADM is $4,000 to $12,000 and does not guarantee that the problem will be fixed.  It is also human cadaver skin that has been removed of its cells, it is not, however, sterile.  So there is limited data.

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.