Breast Revision - Sling Made from Cadaver Skin to Keep Breasts from Dropping?

I had lost about 100 pounds then had a breast lift with implants. I have had 3 revisions since as they keep dropping. The last time the doctor removed the capsil and a lot of extra skin yet they dropped again. Now he is talking about another revision using a sling made out of cadaver skin. Do you know anything about this procedure? He said the other alternative would be to stitch to the ribs. Not sure what to do. He said my problem is that i have thin skin that is not very elastic.

Doctor Answers 15

Alloderm use in revision implant surgery

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Use of Alloderm (freeze-dried and irradiated cadaveric dermis) in revision breast surgery is increasing. Massive weight loss patients tend to have more laxity to their breast connective tissue than non-weight loss patients. Alloderm use is very helpful for these procedures, as it provides support to the lower pole and provides a new layer of soft tissue over the implant. There are other products that work similarly, such as Strattice. The biggest problem with Alloderm is that it is costly, and usually not covered by medical insurance plans in situations like this.

Commonly used "Human Dermis"

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The use of cadaver skin ( more specifically "dermis")  is commonly used in breast surgery.  The technique gained popularity in breast reconstruction surgery specifically with tissue expanders.  The technique used to salvage sagging implants involve the use of STRATTICE (human dermis) which acts a sling to give implants support in skin that lacks support.  Additionally the implant should be downsized to reduce the stress on the skin and implanted STRATTICE.  

Good Luck

Dr. ES

Breast lift revision can work.

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1)  A sling of Alloderm to support the underside of your breasts may be a good idea.  In addition, I would recommend:

2)  Raising the fold under the left breast  (this may be " stitching to the ribs"),

3)  Raising the left nipple, and

4)  Using smaller implants.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Dermal Support For Falling Implants

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The use of biologic materials to help support the implants has incresed dramatically in the past 1-2 years.  Accelular Dermal Matrix (ADM) consist of products that are made from human dermis ( Alloderm), porcine dermis (Strattice), or other materials ( Flex HD, etc.) All are designed for your body to incorporate the material over the course of three months, whil supporting implants that fall too much over time.  They can be expensive, but are very effective at supporting larger implants whenthe tissues are thin.  I hope this helps.

Breast revision - sling made from cadaver skin to keep breasts from drooping?

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Hello! Thank you for your question!  Given your history of failed attempts at revision to correct symmetry and shape issues, consideration for either an acellular dermal matrix or mesh-type substitute is reasonable.  A capsulorrhaphy would be needed for revision of your breast pocket. If you do need such, the use of a dermal matrix or mesh may be considered if your tissue now has significant laxity that is failing in support or a significant deformity in which recreation of the breast pocket is required along with adding additional support and coverage of the implant.  Certainly, the larger the implant, the heavier the weight...thus, it may be useful to consider placement of a matrix or mesh. Otherwise, capsulorrhaphy for pocket revision using your native tissue should suffice.  It has been used safely and effectively to correct synmastia, restore the inframammary fold, mask implant issues (e.g., rippling, wrinkling, etc.), and improve aesthetic results in revisionary breast implant and reconstructive procedures.  However, only by physical examination would one be able to make recommendations on the benefits over the risk of using a matrix or mesh in your situation. 

Consult with a plastic surgeon well-versed in breast procedures and the use of dermal matrices and mesh in breast procedures who will assist you in determining which procedure(s) would be the best for you. 

Strattice or Alloderm

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                  It’s not unusual for massive weight loss patients to require revisional surgery after undergoing cosmetic breast surgery. These patients frequently require large implants to optimize their aesthetic result. They also have thin skin with poor elasticity and as a result, weight loss patients frequently have breast implants that bottom out. When this happens, sag also develops because of the downward pressure of the implant on the overlying soft tissue.

                  When this situation arises support of the breast pocket with an acellular matrix such as Strattice or Alloderm is appropriate. This acts as an internal bra and helps hold the breast implant in place.

                  In patients who have had recurrent bottoming out of implants with associated sag, an acellular matrix is an excellent surgical option. 

Acellurlar Dermal Sling

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With your history of weight loss, thin skin and previous attempts at breast revision to raise the breast fold, the use of an Acellular Dermal Matrix such as Alloderm is a good suggestion. It is highly effective but has not been used as often because of the cost of the material. It is very commonly used in breast reconstruction as insurance pays for it. This is not the case in breast implant revision surgery.

Richard Linderman, MD
Indianapolis Plastic Surgeon

Bottoming out solutions

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Your surgeon is correct. If you have bottoming out with very thin tissues, some surgeons are using Alloderm or any variant of the like to give extra support to the lower pole. It also can help with rippling.

Strattice for bottoming out.

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Strattice would be a great solution for your bottoming out problem.  It will act as an "internal bra" to support and hold the implant in the correct position.  I commonly use Strattice for bottoming out, fold malposition, symmastia, wrinking and rippling, and mastopexy/augmenation. 

Strattice or Alloderm internal bra for implant support

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I have been using these materials for more than 10 years and they have been very helpful in preventing women from getting on the "assembly line" of multiple failed revisions. Just doing the same operation repeatedly is doomed to failure, especially since each time there is more scarring and thinning of the tissue support for the implants. That is where these materials come in; think of them as a living internal bra. Alloderm is made from human skin from a skin bank, with all the cells removed leaving only the collagen matrix. Strattice is a similar material but comes from pig skin. In both cases the body incorporates it and it becomes living tissue for long term support.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.