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Acellular Dermal Matrix for Treatment and Prevention of Implant-Associated
Scott L. Spear, M.D., Steven J. Rottman, M.D., Jeffrey M. Jacobson, M.D., Mitchel Seruya, M.D..
Georgetown University Hospital, Washington, DC, USA.
The use of acellular dermal matrix (ADM) has been increasingly common in prosthetic breast reconstruction. Observed benefits include improved control and support of implant position, better implant coverage, and possibly a decreased capsular contracture rate. Based upon this positive experience, it is not surprising that this technique has been applied to other challenging implant related problems. This study investigates the use of ADM in revisionary breast surgery for correction of implant associated breast deformities.
We performed an IRB approved, retrospective review of our patients who underwent revisionary breast surgery with ADM and implants between November 2003 and August 2010 at Georgetown University Hospital. Patient demographics, indications for ADM, type of ADM and technique of application were identified. Preoperative and postoperative photographs, outcomes of the procedure, complications, and the need for related and unrelated revision surgery were recorded.
84 patients had ADM placed alongside 124 breast prostheses. Average age was 45.2 (range 18-78) and average BMI was 21.8 (range 16.8-33). Indications included capsular contracture (n=51), support (n=33), malposition (n=29), cover (n=23), radiation (n=21), rippling (n=17), symmastia (n= 16), and augmentation-mastopexy (n=13). There was a mean follow-up of 209 days (range 18-1,252). Twenty one ( 17%) breasts were radiated and four (5%) patients were active smokers at the time of surgery.
121 (98%) breast revisions were successfully managed with ADM. Our outcomes were analyzed and revealed two failures (1.6%), one complication (0.8%), and eight unrelated revision procedures (6.4%). The two failures were both capsular contracture recurrences, giving a failure rate of 4% (2/51) in our series of capsular contracture repairs using ADM. The one complication occurred in a patient who developed a right sided methicillin resistant Staph aureus infection requiring device explantation following symmastia repair. Eight unrelated revision surgeries were performed. Indications for these procedures included inferior malposition following treatment of capsular contractures (3 cases), supero-medial contour deformity requiring lipoinfiltration following symmastia repair (1 case), inferior malposition following symmastia repair (2 cases), and bottoming out following augmentation mastopexy with supported with ADM (2 cases).
Based upon our experience in 124 breasts, acellular dermal matrix in difficult revision breast procedures is useful in the treating and preventing recurrence of capsular contracture, rippling, implant malposition, and soft tissue thinning in revision breast surgery.
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