Acellular dermal matrix in regards to capsular contracture

#Capsular #Contracture is a condition in which the capsule around the implant thickens and squeezes the implant making it hard and often changing the shape and position of the implant. It is more common in nicotine users (e.g. smoking or nicotine patches or gum). Effective treatment of the capsule frequently involves completely removal of the capsule (capsulectomy), and occasional incisions in the capsule may be somewhat helpful (#capsulotomy). In the past, closed capsulotomy, in which the breast is squeezed until the #capsule breaks, was used. Currently, most doctors avoid this technique because of complications associated with the technique and because the implant companies will void their warranty if this technique is used. At times it is necessary to change the position of the implant, either above or below the muscle, depending upon the initial position, changing the #implants themselves and, on occasion, the use of Acellular Dermal Matrix (#ADM) may be required to prevent continued problems. A biologic fabric such as an ADM (Acellular Dermal Matrix) can be used to internally attach to the breast tissue while #supporting the implant.

I appreciate your question.
Capsular Contracture is sadly a common occurrence with breast augmentation. I use an IMF incision and antibiotic irrigation to keep the incidence low.  When I'm concerned about capsular contracture I tend to start medical therapy such as singular while working with a primary doctor. If it doesn't get any better in 3-6 months, I then consider removal and replacement of the implants below the muscle while removing the capsule. If they are already under the muscle, I will then consider using ADM. Acellular dermal matrix is a cadaveric graft in which the top portion of the skin (the epidermis or color portion) is removed and the dermis or collagen portion is left behind. All the cells have been removed so it is essentially a collagen graft. Since it is a skin graft, your body grows into it and it becomes your own. This decreases the inflammatory response of healing and so capsulate contracture is less likely.  I have personally seen less recurrence when it is used. I also consider using textured implants as well. Another option if the capsular contracture is long-standing or it recurs, is to remove the implants and perform fat grafting. 
The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
best of luck!
Dr Schwartz
Board Certified Plastic Surgeon 
#RealSelf100Surgeon
#RealSelfCORESurgeon

Acellular Dermal Matrix or ADM is derived from skin that has had all cellular material removed so it is only the connective tissue component. The most common ones are Alloderm, used mostly for breast reconstruction, and Strattice, used more for revisions such as capsular contracture. Although it is possible that CC can recur after placement of Strattice, it is the most effective option we have when combined with capsulectomy and implant replacement. Because of the cost, it is most often reserved for cases where CC has recurred after one revision. However, capsulectomy sometimes leaves a thin tissue envelope around the implant, so Strattice may be considered in primare cases to add support and coverage in addition to protection against CC.

The correct sequence in "fixing" a capsular contracture is as follows:
1- Remove the entire capsule and the implant.
2- If possible, change the pocket (for example, from over the muscle to under the muscle)
3- Place and ADM
By doing the above steps, the recurrence rate is the lowest and you have a good chance of not needing multiple revision surgeries.

Hello, and thank you for your question. (Keep in mind that an in-person consultation is necessary for the best advice.) ADM is very effective about reducing the risk of capsular contracture in the short- and long-term. In the simplest terms, capsule/scar forms around the implant except in the area where the ADM is. Unfortunately, ADM is *very* expensive---so it is not possible to cover the entire breast implant. Best of luck!
Matthew A. DelMauro, M.D.

Acellular dermis is artificial subcutaneous tissue that augments the thickness of the tissue under which it is placed.  It was felt that it seemed to decrease capsular contraction around the implants, but recent studies show it is equal to non placement or use of the acellular dermis

Strattice is the only acellular dermal matrix approved for capsular contracture. It works so well at preventing recurrence that I refuse surgery on patients that have contracture and do not agree to placement of this product. It is quite technique and management sensitive so make sure your PS has experience with this.

An acellular dermal matrix (ADM) is a biologic material that is implanted into your body and incorporates into your tissue.  The most common sources of this material are human, bovine, or porcine.  The tissue is washed/cleansed of cellular components from the donor, so it acts as a scaffolding for your tissues to grow into.  It has a role in capsular contracture surgery as the rates of forming another contracture with an ADM have been shown to be less in some studies.  ADMs are used a great deal in breast reconstruction but also have an important role in revision cosmetic breast surgery as well.  Best advice would be to schedule a consultation with a board certified plastic surgeon who has experience operating with ADM.  Good luck!

Thank you for the question.  Acellular dermal matrix is a biologic implant that carries the ability to become integrated into native tissue. It is made by taking a full thickness section of skin from a donor source (his human, porcine, or bovine in origin).   These materials may be helpful as a supportive matrix, help with the breast implant displacement/malposition,  provide additional support where a capsule repair (capsulorraphy)  is carried out ( such as cases involving bottoming out, lateral displacement, symmastia) etc.  I have also found the material to be very helpful when it comes to treating severe breast implant rippling/palpability concerns.  Furthermore, the acellular dermal matrix is very helpful when it comes to treating challenging/recurrent cases of breast implant encapsulation.
 
You may find the attached link, dedicated to specifically to the use of acellular dermal matrix for breast surgery, helpful to you as you learn more.  You will find a separate page, dedicated to revisionary breast surgery concerns as well.
Best wishes.

Acellular Dermal Matrix (ADM) is actually made from a carefully prepared piece of skin from either human source (allograft) or animal source (xenograft). This material most certainly can play a role in breast revision surgery, specifically to treat capsular contracture. You should schedule an appointment with a board-certified plastic surgeon with experience in the use of ADM.Dr. Edwards