Information on Use of Strattice for Breast Revision?

Question

I am four months post-op and have capsular contracture. I was feeling pain and tightening in my right breast from six to eight weeks post-op. My surgeon said he would do the revision using strattice. I would like to how successful the surgery is in stopping the recurrence of this complication using this material. Also, is the down time as long as with the initial implant surgery. I'm a little apprehensive and in some discomfort. Thank you in advance for your responses.

Richard Baxter, MD · Answer

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.

Johnny Franco, MD, FACS · Answer

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.

Rian A. Maercks, MD · Answer

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.

Robert Cohen, MD · Answer

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!

John J. Corey, MD · Answer

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!

Information on Use of Strattice for Breast Revision?

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Information on Use of Strattice for Breast Revision?

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