Information on Use of Strattice for Breast Revision?

Strattice is an acellular dermal matrix that creates a sort of living internal bra. The finding that it seemed to help prevent recurrence of capsular contracture was fortuitous but it has been successful in every case that I have done, more than a dozen for CC. The implants shoud be replaced at the same time, but it is worth the expense to do the operation with the highest probability of success in my opinion.

Capsular
Contracture and Bottoming out are both uncommon problems but can occur after a
breast augmentation.

Capsular
Contracture can cause hardening of the breast, distortion or pain in severe
cases. This occurs because of the scar
tissue that forms around the implant squeezing it cause the implant to shift
and feel more firm to touch.

Strattice is a
dermal mesh that can be used for multiple purposes in breast surgery. The Strattice is used in capsular contracture
in an attempt to prevent the scar tissue from forming completely around the
implant. The mesh covers part of the
implant and prevents the scar tissue from completely surrounding the implant
and thus the scar tissue cannot squeeze the implant in the same way.

I have used Strattice for capsular contractures and breast revision surgeries since 2009 and have had great success!  Strattice is what is referred to as an acellular dermal matrix. This is an FDA-approved material that can be used as soft tissue reinforcement. Strattice is derived from porcine dermis (the deep skin of pigs). I know, it sounds strange, but it is really a revolutionary product. The porcine dermis is processed so all of the pig cells are removed, leaving a framework, or latticework that your own cells and blood vessels can grow into.
By the way, the use of pig tissues is not new. Porcine heart valves have been used in humans for heart valve replacement for many years. In all of these cases, the body does not reject the material, because all of the pig cells are removed first, leaving a biologically inert framework.
As mentioned earlier, I have had great success using Strattice for correction of first time and recurrent capsular contracture cases. Although Strattice’s FDA approval does not specify its use for correction of capsular contracture (yet), many studies have shown extremely low rates of capsular contracture in patients with Strattice or AlloDerm® (another LifeCell product similar to Strattice but derived from human cadaver skin). The Strattice presumably helped prevent capsular contracture by replacing scar tissue that naturally forms around implants with healthy, regenerated tissue. This helps prevent scar tissue from tightening up around the implants, leaving them soft and natural in appearance.
The downtime after surgery is a little bit longer than with a first time breast augmentation. There are additional precautions I have my patients take to ensure the Strattice incorporates correctly with their tissues.  I use drains to decrease the amount of fluid in the breast pocket and they typically stay in for about a week.  I also have them wear a compression strap for 5-6 weeks to apply a gentle downward pressure, again assisting with the adherence of the Strattice to the patients tissues.  Additionally there are lifting and activity restrictions until patients are 6 weeks post-op.
I hope this information is helpful!  

 

Avoid Stratice!  Your own body has a much better structure: Fascia intelligent use of the subfascial plane is the answer

 

The problems that lead to suggested use of Stratice and dermal fillers are way too common.  The reality of breast augmentation is that most women have similar results and are simply not aware that there is a better option.  The most commonlyt used technique is the  "dual-plane" subpectoral placement.  this sets up the implants for lateral and inferior malposition.  The top of the breast has muscular coverage and because of the pectoralis major's origination next to the sternum, the implants are pushed away from midline creating the valley between them that you dislike ( I call this the Miami Valley based on the common augmented look of breast augmentations in Miami).  Because the inferior portion of the breast is subglandular,  there is no support and the implant tend to migrate toward the armpits then down.

 

For these reasons I do not perform submuscular or dual-plane breast augmentations.  I use a technique that I call "Cold-Subfascial Breast AugmentationTM" that overcomes the shortcomings of dual plane.  By leaving the muscle alone and precisely lifting the strong pectoralis fascia,  I am able to custom design what is essentially a living natural brassiere to support the implant within the breast.  Using this technique I am able to create beautiful natural appearing breasts that complement the individual patient's body.

 

I commonly revise patients in your position by converting them to the cold-subfascial plane.  In my experience this is the only way to repair the breast and create a long-lived beautiful result.  Artificial materials such as stratice are just asking for trouble in my opinion.  I hope this helps!

 

 

All the best,

 

Rian A. Maercks M.D.

I am a Strattice user as well and it does work and is a great product...The downside, however, is that it is still expensive (not as expensive as Alloderm, and the company prefers Strattice in cosmetic cases, anyway) and in a patient that has had one incidence of CC I would probable do aggressive open capsulotomy first, as I have had good success with that. In cases of stubborn CC, Strattice does seem to provide a solution!

All the previous expert info is correct. The cost from $2,000 is an issue. As for enough studies to show an overwhelming positive response use is not there yet. But close. From your written description of post op 4 months to have an operative cc is a bit unusual, but in person if your surgeon believes this is the best option than how could any of us, expert posters, disagree. We can not examine you so I defer to your chosen surgeon. Or you can obtain in person second opinions. 

If you are experiencing capsular contracture following four months post breast implant surgery, you have some options.   After several months of aggressive massage therapy, if the "hardness" does not improve, then one option is to proceed with a total capsulectomy (removal of all the scar tissue around your implant) and replacement with new implants ideally with some form of muscle coverage (under the muscle or dual plane technique).   Another option would be to proceed with a total capsulectomy and replacement of a new implant with partial coverage with Strattice or Alloderm.   Both AlloDerm and Strattice are acellular dermal matrix products (translation = they are sheets of collagen, AlloDerm is from a human cadaveric source and Strattice is from a porcine/pig source).   I have clinical experience with Strattice in revisional implant surgery to correct many problems from previous surgery.

So for your concerns, does use of Alloderm or Strattice make any difference with capsular contracture?  Alloderm has shown promise in slowing the process of scar tissue. In fact, I authored a paper in Plastic and Reconstructive Surgery (the journal for the American Society of Plastic Surgeons)  on this exact topic (dec 2010).  We found AlloDerm to slow down the inflammatory process that is classically associated with Capsular Contracture in our clinical study.  Clinical observations of many experienced breast surgeons show that use of Alloderm or Strattice has great promise in the treatment of capsular contracture. However, it is still too premature to say definitively that alloderm prevents capsular contracture.  

Hope this helps
Dr. Basu

Houston, TX

Strattice is thought to help minimize the recurrence of a capsular contracture. I have not seen studies yet to give exact numbers but it does look promising.  it is also used for rippling as well.

Strattice is a collagen sheet from an animal donor and is used is many areas of surgery including breast reconstruction. For some reason it has been observed that capsular contracture is less evident and breast shape improved, and this has led to the use of Strattice (an allograft) for difficult instances of capsular contracture. The data is not yet in as there are no studies of published data and the expense is significant. You will be part of a 'new idea' but as others have said it can work.

Best of luck, peterejohnsonmd.com

Hi.

People use Strattice because it is less expensive, but it is made from pig skin.  I prefer Alloderm, which is made from human skin.  Both are effective in preventing capsular contracture.  This is an important development..