BACKGROUND: Acellular Dermal Matrix (ADM) has been increasingly accepted as a useful tool in implant-based breast reconstruction. Observed benefits have included better control of the implant position, better support and cover of the implant, and the suggestion of a decreased frequency of capsular contracture. Based upon this positive experience, it is not surprising that ADM would be applied to other challenging implant-related problems. This report is a review of one surgeon’s experience with ADM for correction or prevention of implant-associated breast deformities.
METHODS: A retrospective review was carried out on a single plastic surgeon’s experience between November 2003 and April 2009. Patients who underwent primary aesthetic breast surgery or secondary aesthetic/reconstructive breast surgery using ADM and implants were identified. Patient demographics, indications for ADM, and type of ADM and inset pattern were identified. Pre- and post-operative photos were obtained and complications were recorded.
RESULTS: Eighteen patients had ADM placed alongside 27 breast prostheses, with a mean follow-up of 9.0 months. Indications for ADM use included prevention of implant bottoming-out (n=4) and treatment of capsular contracture (n=3), rippling (n=5), skin flap deficiency (n=8), and malposition (n=14). All cases of capsular contracture, rippling, skin flap deficiency, and malposition were successfully corrected with ADM. There was an 11.1% total complication rate, consisting of 2 infections and 1 hematoma. There were no cases of unanticipated revision surgery and no complications following ADM use in primary aesthetic breast implant surgery.
CONCLUSIONS: Based upon this experience in 27 breasts, Acellular Dermal Matrix has shown promise in treating and preventing capsular contracture, rippling, implant malposition, and soft tissue thinning. This is especially significant because many of these problems have proven extraordinarily difficult to consistently correct in the past.