Breast augmentation is almost always ranked the number one most commonly performed cosmetic surgery in the US each year. In most recent years, over 300,000 procedures have been completed. Given that, it is surprising that revision rates continue to be reported as high as 15-30%, meaning up to thirty in 100 women that have the procedure done require a second surgery. Even more concerning is that 30-40% of those patients who undergo revision, need a second revision. I have written several articles about how to avoid falling into the category of those who need a revision (think conservative size implants placed under the muscle through an incision underneath the breast). However, this article is for those who are facing revisionary surgery and want to make sure they don’t face additional revisions down the road.
The most common reasons patients seek revisionary breast surgery is capsular contracture (scar tissue around the implants), implant malposition, or rippling and wrinkling. Most of these problems can be avoided by making correct decisions prior to the initial surgery, but if you are faced with any of these problems, there are excellent options that have been developed over the last seven to ten years that can dramatically reduce the need for additional revisions.
In the past when capsular contracture occured, resulting in hard, painful or distorted breast shape, a plastic surgeon would take the old implants and scar tissue out, put new implants in, and cross their fingers the scar tissue didn’t recur. Unfortunately, 53% of the time the scar tissue did recur. If this same surgical approach was tried again at the third surgery, a whopping 74% of patients suffered a second episode of capsular contracture and had to face a fourth surgery. In spite of this, this technique is still utilized over and over again.
Thankfully acellular dermal matrices (ADM’s) were developed and have dropped recurrent capsular contracture rates dramatically. ADM’s are soft tissue replacements made from human cadaver or porcine (pig) skin. All of the cells are removed from these products and only a collagen latticework remains. Consequently there is no possibility of rejection, and infection rates are incredibly low. Once implanted in the breast implant pocket, blood vessels grow into the ADM, thickening surrounding tissue that has frequently been thinned by scar tissue. The rates of recurrent capsular contracture after placement of these ADM’s is 0-6%, compared to 53-74% without it.
One might ask themselves why any surgeon who knows this data would suggest proceeding with revisionary implant surgery without using these products. I often ask myself this question as well! However, I probably do know the potential reasons. One reason is that some surgeons don’t stay up to date on the data and continue to perform their same old techniques. Another reason is the products are expensive (but not nearly as expensive as a third or fourth surgery!) Finally, the products are technically challenging to learn how to use and take more time in surgery than old fashioned techniques. I am here to tell you that any added cost or inconvenience is more than made up for by the amazing results obtained.
There are many ADM’s available, but I prefer the product called Strattice, which is a porcine derived ADM. I have used it for over five years now and as of yet, have not had a patient develop recurrent scar tissue around their implants. I have also used it in many cases for mal-positioned implants, frequently called bottoming-out, and for problems with wrinkling and rippling. If you are facing a revisionary breast implant surgery, or worse yet, a revision of a revision, and the surgeon you see does not mention an ADM, keep looking. I have had too many patients tell me their other plastic surgery consultant told them they, “didn’t need an ADM,” only to see them back a year later with the same problem they had before their last revisionary surgery where an ADM wasn’t used. Do your research and you can significantly reduce your chance of needing yet another breast surgery.
Categorized in: Our Practice
