What Can I Do For Paper Thin Skin?

Question

I had implant replacement done 02/14/13, from 330cc to 540 ccs saline unders- the skin under the right breast toward the middle of my body by the incision, feels paper paper thin - I can feel the implant - about 2 inches long. I have seen the nurse practioner about 3 times since the surgery - she says they look fine, but agrees with me the skin is paper thin and I am feeling the implant. I will see the doctor April 11th. What can I do in the mean time to toughen up up thicken up the skin.

William T. Stoeckel, MD · Answer

Unfortunately, there is probably nothing that you can do to improve the quality of your skin. And having a large implant will only cause the skin to continue to thin even more with time. Surgically, I think that your options include fat grafting or placement of an acellular dermal matrix under the skin. Both of these options can be rather expensive, but large implants with thin skin almost always leads multiple operations.

Richard H. Tholen, MD, FACS · Answer

This area of the breast is where muscle fibers must be (partially) released, and where there is no breast tissue and usually very little fat. You are not alone in this anatomy. As for what to do--in a word, nothing. There is really nothing that you can do to thicken or toughen these layers of tissue.

	Your body is forming a scar capsule around your implant, and the fact that this is a revision gives your surgeon an idea how thin your capsule was after your initial augmentation. You can reasonably expect this time to not be much different.

	Your surgeon has the most explicit information about you and your specific anatomy, and will be able to give the best answer regarding this, but I would tell you that you should not pinch or manipulate this area to prevent further thinning or breakdown, let the tissues heal and scar as they will, and see how things end up.

	If this area persists as a bothersome thin layer, re-operation for placement of an acellular dermal matrix (ADM) such as Alloderm, Strattice, or SurgiMend can provide another layer of tissue as your body replaces the ADM with its own collagen. Use of your own tissue capsule as an internal flap is another option potentially available, should surgery be deemed necessary.

	It is a bit early to be worrying about this, and there is nothing (beneficial) that you should be doing other than following your doctor's recommendations, so do just that--see what your plastic surgeon says. Waiting until April 11 is just fine as far as I can tell, but you can always see him earlier if this concerns you! Best wishes! Dr. Tholen

Jeffrey Zwiren, MD · Answer

The ideal solution is to use an ADM (Acellular Dermal Matrix) material to form an internal sling to support your implant and provide some degree of soft tissue coverage. Typically this material is sown along the lower edge of the pectoralis muscle and then along the inframammary crease. This then provides full soft tissue coverage and can help mask the feel of the implant, especially if you have saline implants. The problem with this material is that it is not cheap.

James Apesos, MD · Answer

Are your implants under the muscle? Sounds like these are too big and that you could eventually have skin erosion and implant extrusion. I would expect to see my doctor sooner rather than later in this situation. There are common dermal fillers that are skin which is processed from cadavers or pigs that are placed under the skin to both protect the implants and thicken the area of thin skin. Otherwise place the implants under the muscle.

Tal T. Roudner, MD, FACS · Answer

As mentioned before ADM such as thick stratisse will add a more thickness to the thinning skin, fat injections and reducing the size of the implants are the best options to help this problem.

Steven Wallach, MD · Answer

Unfortunately this can be a problem for many patients. Sometimes strattice is added to thicken the coverage over the implant.

Tamir Mosharrafa, MD · Answer

Unfortunately, there is not much you can do to increase the amount of soft tissue covering your implants. There are surgical options you can discuss with your surgeon on the 11th including fat transfer and the use of an acellular dermal matrix graft. These grafts are effective at providing thicker coverage and reducing palpable rippling, but they are quite expensive (typically costing more than your implants). Fat may be a more cost effective means of correction, but may also require more than one session. I wish you luck.

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