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Treatment of Capsular Contracture Using Complete Implant Coverage by Acellular Dermal Matrix: A Novel Technique

Cheng, Angela M.D.; Lakhiani, Chrisovalantis B.S.; Saint-Cyr, Michel M.D.

Plastic and Reconstructive Surgery: September 2013 - Volume 132 - Issue 3 - p 519–529
doi: 10.1097/PRS.0b013e31829acc1e
Breast: Original Articles
Discussion
Coding Perspective

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.

Supplemental Digital Content is Available in the Text.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.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s Web site (www.PRSJournal.com).

Michel Saint-Cyr, M.D., Division of Plastic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minn. 55905, saintcyr.michel@mayo.edu

©2013American Society of Plastic Surgeons