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A Simple Technique to Enhance Breast Aesthetics Using Porcine Acellular Dermal Matrix (Strattice) in Breast Reconstruction

Abood, Ahid M.R.C.S., F.R.C.S.(Plast.); Rhodes, Nicholas F.R.C.S.(Plast.)

Plastic and Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 633e–634e
doi: 10.1097/PRS.0b013e318262f698
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Royal Adelaide Hospital, Adelaide, South Australia, Australia

Bradford Royal Infirmary, Yorkshire, United Kingdom

Correspondence to Dr. Abood, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia ahidabood@hotmail.com

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Sir:

A recognized role in breast reconstruction is being developed for the use of acellular dermal matrices (Strattice and AlloDerm; LifeCell Corp., Branchburg, N.J.). Advocates of their use report that in addition to providing extra tissue for implant coverage, they hide potential implant visibility and further enhance breast aesthetics by giving the surgeon greater control of the breast pocket, specifically, allowing the surgeon to define the lateral and inframammary folds.1 We report a simple technique, developed from the senior author’s experience with Strattice, used to aid its precise insertion and therefore enhancing these key aesthetic features in the reconstructed breast.

  1. Standard preoperative skin markings are undertaken that define the breast “footprint.” In unilateral reconstructions, the contralateral side is used to reference these.
  2. Intraoperatively, the surgeon aims to recreate the breast envelope. The preoperative cutaneous markings are continuously referenced throughout the development of the breast envelope so as not to create an oversized pocket for the implant.
  3. Once the envelope has been developed, accurate insertion of the precise level of the inframammary fold, from looking within, is determined by passing a 23-gauge needle transcutaneously, through the skin marking of the inframammary fold, until the tip is seen within the pocket (Fig. 1).
  4. With the needle tip identified, a small amount of methylene blue is dropped through the hub end of the needle and is seen to mark the exact level of the inframammary fold marking. The needle is then withdrawn.
  5. Steps 3 and 4 are repeated along the inframammary fold.
  6. The internal markings now allow accurate placement of anchoring sutures onto the chest wall, thereby enabling the Strattice to precisely define the lateral and inframammary folds (Fig. 2).
Fig. 1

Fig. 1

Fig. 2

Fig. 2

The use of Strattice and other acellular dermal constructs have a developing role in breast reconstruction. They have the potential to enhance breast aesthetics, particularly through definition of the lateral and inframammary folds. The simple technique described allows this potential to be consistently and predictably realized.

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DISCLOSURE

No financial support or benefits have been received by the authors, nor do they have any relationship from any commercial source which is related directly or indirectly to the scientific work which is reported on in the article.

Ahid Abood, M.R.C.S., F.R.C.S.(Plast.)

Royal Adelaide Hospital

Adelaide, South Australia, Australia

Nicholas Rhodes, F.R.C.S.(Plast.)

Bradford Royal Infirmary

Yorkshire, United Kingdom

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REFERENCE

1. Namnoum JD. Expander/implant reconstruction with AlloDerm: Recent experience. Plast Reconstr Surg.. 2009;124:387–394
©2012American Society of Plastic Surgeons