The Use of Human Acellular Dermal Matrix for the Correction of Secondary Deformities after Breast Augmentation
Sumner A. Slavin, M.D., Tristan L. Hartzell, M.D., Jerry W. Chang, M.D., Samuel J. Lin, M.D..
Harvard Medical School, Boston, MA, USA.
PURPOSE: Secondary breast deformities following breast augmentation constitute some of the most challenging and difficult problems to correct. Causes include surface irregularities (rippling/wrinkling, bulging, capsular contracture), implant malposition, inframammary fold malposition with or without bottoming out of the lower pole, and hyperdynamic deformity caused by excessive division of the pectoralis major muscle medially. Although the application and efficacy of human acellular dermal matrix in immediate breast reconstruction with tissue expanders has been previously reported, there is little information in the literature relating to its indications or results in aesthetic breast surgery. The purpose of this study was to evaluate the different defects occurring after breast augmentation and the result of treatment with human acellular dermal matrix.
METHODS: This study retrospectively reviewed a single-surgeon’s experience in correcting secondary deformities after breast augmentation from 2005-2009. A total of 26 patients ( 46 breasts) were included in the study. Pre-operative evaluation and symptoms, intra-operative findings and interventions, and post-operative follow-up were reviewed.
RESULTS: There were 30 breasts with surface irregularities, 26 breasts with implant malposition, 4 breasts with inframammary fold malposition, and 5 breasts with hyperdynamic deformity. On average, 1.17 sheets of human acellular dermal matrix (price range $3393 to $4563) were used per breast per operation. Twenty-two out of 26 (85%) patients had improvement of their breast deformity after breast revision surgery and placement of human acellular dermal matrix. Four patients (15%) needed another cosmetic breast operation before the end of the follow-up period: 3 due to persistent surface irregularities and 1 with a request for larger implants. There was one complication (4%) of an infection requiring removal of the human acellular dermal matrix and replacement during an additional procedure. The average follow-up time was 26 months with a range of 4-62 months.
CONCLUSION: Human acellular dermal matrix is a useful and safe adjunct for correction of contour deformities after breast augmentation. This technique improves cosmetic appearance of deformities by adding reinforcement to capsule, breast tissue, and capsulorrhaphy repairs. Its high cost, however, may be a deterrent to widespread use in self pay (cosmetic) patients. No conclusions could be determined regarding the effect of human acellular dermal matrix to prevent/decrease the incidence of future capsular contractures.