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

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.

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. 

                  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. 

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.

This is a technique which has been popularized in part by the work of Dr. Scott Spear. There are studies to suggest that it becomes part of you . It can act like a support to reinforce the postion of the implant. Certainly, I would consider it as an option in a difficult case such as yours.

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

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.

Hello imloved04, ADM sheeting is a useful tool for the prevention and correction of several issues associated with breast implant revision surgery. It's a very reasonable suggestion with your history, just make sure your surgeon has experience using the product. I think what your surgeon said is your skin is TOO elastic. After dramatic weight loss it has been stretched in excess, which is very detrimental to the skin quality. Once your skin is stretched, that's it! The quality of that skin is poor. It can't hold weight and keep it's shape. A mastopexy will lift and cut away some of the the stretched tissue, but the skin that remains is still this poorer quality. Add to that the weight of an implant (the larger the implant, the more weight) and gravity will cause the breast to sag again. We can remove skin all day, but when the quality of the existing skin is poor, it will always stretch again. This can be anywhere on the body, face, thighs, arms and abs. Good luck!

I agree with many of the other comments but beware, there is a chance of infection using  Alloderm or other similar products. Unfortunately, you are to that place however. I might get another opinion as surely he would have offered this by now. Look for a board certified plastic surgeon that has lots of experience using this stuff.

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.