Strattice for Breast Augmentation Revision to Prevent Movement into Armpits

Strattice for Breast Augmentation Revision -- to use or not to use -- is that the question?

Other surgeons here have given varying opinions about using a material such as Strattice. The reality is that there is not a single answer. While purported benefits of using Strattice include situations such as yours (thin tissues and need for additional reinforcement of the implant pocket), it really comes down to an assessment of your own tissues to determine what we are working with.

Your surgeon has made a recommendation to use Strattice and to downsize your implants. This sounds reasonable. And without being able to examine you, I wouldn't be able to make a different recommendation.

While your are quite thin, I have had other thin patients that have had great success with revising an implant pocket without the use of Strattice, particularly when using a silicone implant. I also feel that using silicone gel implants and downsizing both weigh a bit against using Strattice.

Hope this helps,

Nick Slenkovich, MD FACS

 

 

Hello! Thank you for your question!  Given your history and 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.

Avoid Stratice! Your own body has a much better structure: Fascia intelligent use of the subfascial plane is the answer

 

Avoid Stratice!  Your own body has a much better structure: Fascia intelligent use of the subfascial plane is the answer

 

The problems that lead to suggested use of Stratice and dermal fillers are way too common.  The reality of breast augmentation is that most women have similar results and are simply not aware that there is a better option.  The most commonlyt used technique is the  "dual-plane" subpectoral placement.  this sets up the implants for lateral and inferior malposition.  The top of the breast has muscular coverage and because of the pectoralis major's origination next to the sternum, the implants are pushed away from midline creating the valley between them that you dislike ( I call this the Miami Valley based on the common augmented look of breast augmentations in Miami).  Because the inferior portion of the breast is subglandular,  there is no support and the implant tend to migrate toward the armpits then down.

 

For these reasons I do not perform submuscular or dual-plane breast augmentations.  I use a technique that I call "Cold-Subfascial Breast AugmentationTM" that overcomes the shortcomings of dual plane.  By leaving the muscle alone and precisely lifting the strong pectoralis fascia,  I am able to custom design what is essentially a living natural brassiere to support the implant within the breast.  Using this technique I am able to create beautiful natural appearing breasts that complement the individual patient's body.

 

I commonly revise patients in your position by converting them to the cold-subfascial plane.  In my experience this is the only way to repair the breast and create a long-lived beautiful result.  Artificial materials such as stratice are just asking for trouble in my opinion.  I hope this helps!

 

 

All the best,

 

Rian A. Maercks M.D.

 

Without personally examining you and discussing your goals, no one can give you definitive advice. It sounds like you are thin and the implants are large for your size, which can lead to stretching and thinning of the tissues around the implant and loss of support. If this is the case then the tissues would need to be reinforced and Strattice is a very good way to do that. On the other hand, if an revision is attempted and it fails, that can lead to even more thinning and a worse problem, not to mention spending more money in the long run than the cost of Strattice.

I am sorry about the complication you have experienced. Most patients who undergo this type of revisionary breast surgery benefit from capsulorraphy (internal suture repair). This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation. In my practice, I use a 2 layered suture repair, supporting the involved area. I do not find the use of acellular dermal matrix or mesh necessary for the majority of patients who present with breast implant displacement problems. Factors such as recurrence of breast implant displacement/malposition and the presence of poor quality skin/tissue support come into play when making a decision to recommend/utilize additional support materials.Generally speaking, the use of acellular dermal matrix or bio synthetic mesh for patients in your situation may be helpful occasionally. This material may be helpful as a supportive matrix and help with the breast implant displacement/malposition you are experiencing. Again, I usually recommend their use depending on the patient's anatomy ( for example quality/elasticity of the involved skin) and past surgical history.You may find the attached link, dedicated to revisionary breast surgery (demonstrating many cases of corrective surgery for patients with "bottoming out" of breast implants) helpful to you as you learn more. You will find a separate page, on the same website, dedicated to lateral displacement situations specifically.Best wishes.

Runnermomof3: I agree that choosing a silicone gel implant, which has a base diameter or "footprint" which is similar to yours, will produce a result which approximates the one you have now.  If your implants are 10 years old, I'll bet they were "standard" profile, which will overwhelm your frame.  You might ask your PS whether the intermediate or high profiles would be preferable. 

The space or pocket, in which your implant resides, must be made more narrow.  This can be done either by applying Strattice, as an inferolateral "hammock" or by simply suturing the lower outer aspect of the pocket with a permanent suture, in a technique called suture capsulorrhaphy.  Both Strattice and suture capsulorrhaphy have the potential to be painful but in the long run, really worthwhile.  If Strattice is used, the drain usually stays in until the output is 25-30cc/day and the patient must agree to restrict their activity for at least 2 weeks. 

So you could achieve this effect without Strattice, although I agree that it is a more reliable insurance policy against relapse.  Good luck.

Strattice is an 'allograft' actually pig skin and the role in breast augmentation revision is controversial. Don't expect surgeons to be on the same page on this one. Our feeling is that the role, possible in reduction of capsular contracture is not defined. It has been marketed to hold implants in position and prevent 'bottoming out' though again has several drawbacks, and for most may be unnecessary. Get additional opinions. My vote would be to focus and revising the shape or location of the pocket alone.

Best of luck,

peterejohnsonmd

In my practice we have used Strattice to help with capsular contracture, thin skin issues and implant displacement.  It is expensive but if you consider it over the long haul, and the fact that it corrects the problem ... it is worth it.   There are no other options at this point for these issues. 

Pictures would help in your case to determine the most appropriate treatment for you.

A good board certified plastic surgeon will be able to assist you in your treatment.

Good luck to you.

 

Dr. Kimberly Henry

San Francisco ,CA

Very difficult to advise without an in person evaluation. Yes it is $2,000 more expensive and there are no guarantees. I use drains for 4 days to a week on average. Size is between you and your chosen surgeon.  

I agree Strattice is expensive.  For your type of revision it may be unnecessary.  If you are considering switching to gel implants, you can place them subfascial and not have to be concerned with the submuscular pocket.  The other choice is to create a new pocket under the muscle and between the old capsule referred to as a neopocket.  Finally, you can use the old pocket and close off the area where the implants displace. You have lots of surgical options.  Personally the easiest, quickest and with the least amount of risks is to place the implants subfascial.  Discuss these options with your surgeon and good luck.