When Are "Pig Skin" Linings Necessary After Encapsulation Surgery ?

The use of the pig skin lining is actually more related to recent reports of cadaveric skin (called acellular dermal matrix, commonly known as Alloderm) that has been shown to lower the risk of recurrent capsular contracture. The mechanism for this is unkown. I think that you could get by with a simple implant removal and capsulectomy. Alternatively, I have had much success with a neopectpral pocket.

Breast implants that are long-standing and encapsulated typically require complete capsulectomy and implant removal and replacement. If your overlying tissues are already quite thin, and you take out the scar layer around the implant, you are thinning your tissues even more. In the setting of thinness, the implant can be more visible, prone to rippling, and skin sagging can sometimes be an issue. Treatment options for me usually start with pocket site change to submuscular if it isn't already, with or without skin tightening procedures such as breast lifting. In patients with recurrent contractures and history of multiple surgeries, when options for local tissue coverage have been exhausted, then the addition of Alloderm (human skin) or Strattice (pig skin) may be necessary to provide coverage over your implant and reduce implant visibility.

Soemtimes, when the implants have been in for many years and they have become completely encapsulated, it is necessary to remove all of the old scar tissue and implant material.  What can happen sometimes is that the new implant does not have enough tissue to support it because they have been weakened by removing the old capsule.  In those cases, it is nice to support theimplant with some sort of biological material that your body will incorporate into its own over the course of 6-8 weeks.  There are a number of different types, but they are all based on dermis from either humans or some type of animal ( porcine, bovine, etc.).  I hope this helps.

The 'pig skin' product that you are referring to is Strattice, which is a porcine derived acellular dermal matrix product. It can be used for a variety of revisionary breast surgery applications. It is not necessary, and I don't even think there is solid clinical data to support the necessity of using Strattice after capsulectomy to prevent recurrent capsular contracture.

Where Strattice is enormously helpful is for patients with implant malposition and soft tissue coverage issues. Seek out a board certified plastic surgeon with some experience using Strattice for an expert opinion.

Alloderm ( which is from humans) and variations of treated pig skin are used for lining in situations where better coverage is needed for the implant such as in cases of rippling.  It is also used sometimes to reinforce the fold and also in breast recosntruction.

I often use Surgimend ("cow skin") when I do implant revisions for significant capsular contractures in women with thin skin and only a small amount of breast tissue.  Strattice ("pig skin") and Alloderm ("human skin") are also used for the same purpose.  They are helpful tools during tough revisions, such as yours.

The body creates a thin layer of scar tissue around every foreign object be it a pacemaker, bullet, artificial blood vessel or breast implant. In a small number of cases thethin scar becomes a thick scar CONTRACTURE which squeezes the implant and may be painful.
There are several ways of dealing with such CAPSULAR CONTRACTURE (oral asthma medications, taking Vit. E, putting cuts in the scar to weaken it (CAPSULOTOMY), changing the implants to a different location with removal of part or all of the scar capsule (CAPSULECTOMY)). Unfortunately, in a significant number of cases, the contracture scar comes back.
In recent years, it hasbeen shown in several studies that implant exchange, scar removal and the sewing in a what remains of a skin after all the cells are removed (Acellular Dermal Matrix - ADM) appears to prevent an expected recurrence of a capsular contracture.
It SOUNDS like you have 32 year old implants (which by now have probably leaked) associated capsular contracture. To correct it you would need to have the implants AND the capsule scar removed. New Implants would need to be put in but would have a higher rate of NEW capsular contracture. If you wanted to take every known precaution to lower the odds of new scar formation you may want to have asking of ADM (either Alloderm(human skin) or Strattice (pig skin)) used around the lower pole of the implant to support it, provide added thickness and cover and prevent capsular contracture recurrence.
Dr. Peter Aldea

You implants are really old and surely ruptured.  That generation of implants had very thin and weak shells and rupture is common.  The rupture likely caused inflammation, the inflammation lead to excess scarring which we call capsular contracture.

I would recommend having your old implants out along with the capsule and have new implants placed.  I wouldn't recommend pig skin unless your tissues are super, super  thin.  In that case, I would remove your implants and capsules, let things heal and settle down for a few months and then start over with new implants and maybe pig skin.

Pig skin and other dermal products may possiblly decrease the incidence of recurrent capsular contracture of uncertain cause, meaning that there is no obvious reason for the capsule.    But in your case, with such old implants, a rupture and capsular contracture are expected.

These dermal products are very, very expensive and are being heavily marketed to Plastic Surgeons.  They work well when needed but most patients don't need them.

My humble opinion.

Lisa Lynn Sowder, M.D.