Surgical mesh vs. alloderm for breast implants?

Question

I had surgical mesh placed under my Breast implant due to paper thin skin and I can't stand it. It is hugely visible and palpable and it grosses me out. I am contemplating having my surgical mesh replaced with alloderm. I know it's expensive and don't mind the cost if it will be more natural feeling. Will my result be considerably better?

Harry T. Haramis, MD, FACS · Answer

It depends on what mesh was used, biologic ones usually soften as they are incorporated over months. Alloderm, Strattice, etc are costly but may be worth considering after discussing with your plastic surgeon.

Larry S. Nichter, MD, MS, FACS · Answer

Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another.  See the below link on some suggestions on finding the most qualified Plastic Surgeon for a Breast Augmentation Always insist on a board certified plastic surgeon.

Dallas Buchanan, MD · Answer

Thank you for your question. Without an in-person exam, it can be hard to give you a straight answer. If you are palpating the mesh, then you likely have very thin soft tissue coverage, so any revision to this area is going to be difficult. That being said, ADM products such as Alloderm are usually more uniform and smooth than a piece of mesh and could produce more ideal results with greater cost. Also, if the soft tissue thickness is the problem, fat grafting may be another option to consider. Hope this helps!

Gerald Minniti, MD, FACS · Answer

Hello,I find that the role of biologic materials like ADMs are shrinking to just capsular contracture treatment. Surgical meshes are cheaper and do not require drains for the purpose of implant support (internal bra), and the use of ADMs for 'thickening the tissue' is a proven failure.  If your tissue is thin, the only remedy is fat grafting. Best of luck!

John J. Corey, MD · Answer

Thin tissue is definitely a challenge in breast implant surgery. Hiding the implant from the outside world can be tricky. We try to keep things under the muscle as much as possible and the newer cohesive gel implants help as well.  Bringing in coverage from outside can be just as challenging and AlloDerm is certainly one option. It is expensive and it comes from a human source. Strattice is an animal tissue that is also used… Not as expensive and is a little thicker.  Fat grafting is another possibility that can be used.  I wish we could give you a definite answer here but you will need to find someone that has vast experience in all of these modalities.

Urmen Desai, MD, MPH, FACS · Answer

Difficult to determine as every case is different for each individual person.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified Beverly Hills Plastic Surgeon

Tim Sayed, MD, MBA, FACS · Answer

Are your implants under the muscle?I certainly am not a fan of surgical mesh in the breast and NEVER use prosthetic mesh, even if it is absorbable. I do use ADM (Alloderm or Strattice commonly) for support and coverage but it depends on the reason and the specific issue. Are you seeing rippling or implant borders through the skin, or what is the specific issue that led to the use of the mesh? Was it to support a lift? I'm seeing more plastic surgeons using Galaflex to support breast lifts but am not convinced it makes a long term difference for lift support alone. For improving the shrouding of the implant in patients with thin tissues, ADM's may be helpful. It might require a multi-stage approach including fat grafting to add additional soft tissue coverage. Without photos and an exam it's hard to say for sure. Consultation in the office is the best approach, of course.

Sean Kelishadi, MD · Answer

Hello and thank you for your question.  Without photos and/or an in-person examination it is difficult to give you accurate advice.  Surgical meshes and acellular dermal matrices like alloderm can be used for soft tissue support, but remember that these are tools to help the surgeon create the final result. The tools used don't make the surgery go amazing but rather the skilled surgeon using the tools at their disposal to their best ability is what you are looking for.  It sounds from your description that you have a challenging problem.  You would be best served with a consultation with a board certified plastic surgeon with expertise in breast revision. That person will need to assess your tissue quality, implant position relative to your breast pocket, fat stores available and then make recommendations for whether or not you need capsule work, fat grafting, biologic meshes, breast lifting, etc to get you your optimal results.  Also, the new highly cohesive gel Inspira implants made by Allergan are able to decrease the incidence of rippling and other deformational changes to the implant and decrease the need for meshes and biologic slings. I hope this helps and best of luck to you.
Sincerely,
Dr. Sean Kelishadi

Nicholas A. Flugstad, MD · Answer

Some mesh can be palpable and unnatural. For significant implant revisions where mesh is required, I recommend Strattice. It has many of the same properties as Alloderm but for a much more affordable price.

Julio Clavijo-Alvarez, MD, MPH, FACS · Answer

I am sorry that you are having issues about your procedure and thanks for sharing your question. I can appreciate your concern.
Alloderm or other biological scaffolds may have a more natural feel when trying to provide support in thin breast. However, integration and fluid production may required prolonged use of drains. Despite helping with the support of your implant, fat grafting to improve the padding of the natural tissues may be needed to improve the natural look that you want to achieve.Finally, make sure that you have a consultation with a board certified plastic surgeon.
  
Wishing you the best in your journey

Surgical mesh vs. alloderm for breast implants?

Answers (13)

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