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Acellular Dermal Matrix for the Treatment and Prevention of Implant-Associated Breast Deformities

Spear, Scott L. M.D.; Seruya, Mitchel M.D.; Clemens, Mark W. M.D.; Teitelbaum, Steven M.D.; Nahabedian, Maurice Y. M.D.

Plastic and Reconstructive Surgery: March 2011 - Volume 127 - Issue 3 - p 1047-1058
doi: 10.1097/PRS.0b013e31820436af
Breast: Original Articles

Background: Acellular dermal matrix has been increasingly accepted in prosthetic breast reconstruction. Observed benefits include improved control and support of implant position, better implant coverage, and the suggestion of a decreased capsular contracture rate. Based on this positive experience, it is not surprising that acellular dermal matrix would be applied to other challenging implant-related problems. This study investigates the use of acellular dermal matrix for correction or prevention of implant-associated breast deformities.

Methods: Patients who underwent primary aesthetic breast surgery or secondary aesthetic or reconstructive breast surgery using acellular dermal matrix and implants between November of 2003 and October of 2009 were reviewed retrospectively. Patient demographics, indications for acellular dermal matrix, and acellular dermal matrix type and inset pattern were identified. Preoperative and postoperative photographs, success or failure of the procedure, complications, and need for related or unrelated revision surgery were recorded.

Results: Fifty-two patients had acellular dermal matrix placed alongside 77 breast prostheses, with a mean follow-up of 8.6 months (range, 0.4 to 30.4 months). Indications included prevention of implant bottoming-out (n = 6), treatment of malposition (n = 32), rippling (n = 20), capsular contracture (n = 16), and skin flap deficiency (n = 16). Seventy-four breasts (96.1 percent) were managed successfully with acellular dermal matrix. Three failures consisted of one breast with bottoming-out following treatment of capsular contracture, one breast with major infection requiring device explantation, and one breast with recurrent rippling. There was a 9.1 percent total complication rate, consisting of three mild infections, one major infection necessitating explantation, one hematoma, and one seroma.

Conclusion: Based on this experience in 77 breasts, acellular dermal matrix has shown promise in treating and preventing capsular contracture, rippling, implant malposition, and soft-tissue thinning.

Washington, D.C.; and Los Angeles, Calif.

From the Department of Plastic Surgery, Georgetown University Hospital, and the David Geffen School of Medicine at the University of California, Los Angeles.

Received for publication April 18, 2010; accepted August 13, 2010.

Presented in part at the 26th Annual Meeting of the Northeastern Society of Plastic Surgeons, in Charleston, South Carolina, September 23 through 27, 2009, and the 2010 Plastic Surgery Senior Residents Conference, in Anaheim, California, January 20 through 23, 2010.

Disclosure: Dr. Spear is a paid consultant for LifeCell and Allergan. Dr. Teitelbaum is a consultant for LifeCell, Allergan, and Kythera Biopharmaceuticals. Dr. Nahabedian is on the speaker's bureau for LifeCell. Drs. Clemens and Seruya have no financial interest in any of the products, devices, or drugs mentioned in this article.

Scott L. Spear, M.D.; Georgetown University Hospital; 3800 Reservoir Road, N.W.; PHC Building, First Floor; Washington, D.C. 20007;

©2011American Society of Plastic Surgeons