Background: Capsular contracture is a frequent complication of breast reconstruction that affects 2.8 to 15.9 percent of patients. Use of acellular dermal matrix has been reported for treatment of contracture, with a recurrence rate of 6.3 percent, but this was limited to partial implant coverage only. The authors describe a novel surgical technique using acellular dermal matrix to completely cover the implant anteriorly to treat and prevent capsular contracture.
Methods: Charts were reviewed to identify patients who had received implant insertion with complete acellular dermal matrix coverage performed by a single surgeon. Patient demographic information, history of irradiation or capsular contracture, prior treatment, and postoperative complications were recorded.
Results: Eleven patients (16 breasts) were identified. Mean age and body mass index were 52.3 ± 6.9 years and 23.6 ± 4.4 kg/m2, respectively. Four patients (five breasts) had a history of capsular contracture requiring previous capsulectomy and implant exchange. Ten cases were for correction of new-onset grade III (n = 2) or IV (n = 8) capsular contracture and one was to prevent future capsular contracture. Mean acellular dermal matrix size was 229.8 ± 46.5 cm2 (range, 144 to 256 cm2). Average follow-up was 9.2 months (range, 2.4 to 18.8 months). One patient (one breast) developed an infection requiring implant removal. No patients experienced recurrent capsular contracture.
Conclusions: Capsular contracture may be treated successfully using complete acellular dermal matrix coverage. This technique may be a useful addition to therapies currently used to treat recalcitrant capsular contracture (early recurrence or refractory to standard therapy).
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Coding Perspective for this Article is on Page 528.
Dallas, Texas; Atlanta, Ga.; and Rochester, Minn.
From the University of Texas Southwestern Medical Center; Emory University; and the Division of Plastic Surgery, Mayo Clinic.
Received for publication October 13, 2012; accepted January 9, 2013.
Disclosure: Dr. Saint-Cyr is a paid speaker/consultant for LifeCell. The other authors have no financial disclosures to report.
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Michel Saint-Cyr, M.D., Division of Plastic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minn. 55905, firstname.lastname@example.org