Sutures vs ADM for bottomed out breast implants
Most plastic surgeons in Honolulu are aware and can use ADM or Acellular Dermal Matrix materials for support of bottomed out implants, but the cost can be prohibitive for many budgets. This is state of the art reconstruction for difficult breast problems, however. Many issues with smaller implants can be corrected affordably with stitches only, but heavier breasts and implants will need stonger materials and therefore, may benefit from the ADM reconstruction. These materials are derived from processed pigskin or other biologic materials to remove the cellular antigens. A recent release by Allergan makes use of a processed silk fabric which is very applicable to reinforcing the breast implant capsules.
Sutures are the traditional method of correcting this problem. However, bottoming out can recur even with stitches. I am using either Strattice or Seri to reinforce sutures, which works very well. All cases I have performed have been successful. Seri has certain advantages that make it an ideal material for this type of purpose. All of these materials are quite expensive and this is a disadvantage of using these materials.