The Use of Human Acellular Dermal Matrix for the Correction of Secondary Deformities after Breast Augmentation
Tristan L. Hartzell, M.D.1, Amir H. Taghinia, M.D.2, Jerry W. Chang, M.D.2, Samuel J. Lin, M.D.2, Sumner A. Slavin, M.D.2.
1Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA, 2Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
Background - Secondary breast deformities following breast augmentation constitute some of the most challenging and difficult problems to correct. These deformities include surface irregularities (rippling/wrinkling, bulging, capsular contracture), implant malposition (including 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 breast reconstruction has been previously reported, there is little information in the literature relating to its indications, results, or cost in aesthetic breast surgery. The purpose of this study was to evaluate the different defects occurring after breast augmentation, the result of treatment with a human acellular dermal matrix, and the associated expense to these self-pay patients.
Methods - This study retrospectively reviewed a single-surgeon’s experience in correcting secondary deformities after breast augmentation from 2005-2010. A total of 24 patients (40 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 and 22 breasts with implant malposition (12 had both). Five breasts had the pectoralis major muscle hyperdynamic deformity. On average, 1.13 sheets of human acellular dermal matrix (thick or ultra-thick, size range from 96 to 128 square centimeters) were used per breast per operation. At our institution, this material equates to a cost of US $3536 to $4856 per breast (depending on sheet size and thickness). 21 of 23 (88%) patients (34 out of 40 breasts; 85%) had improvement in their breast deformity after breast revision surgery and placement of human acellular dermal matrix. Three patients (six breasts) needed another cosmetic breast operation before the end of the follow-up period: 2 due to persistent surface irregularities and 1 with a request for larger implants. One patient had an infection in one breast (1/40; 3%), requiring removal of the human acellular dermal matrix and replacement during an additional procedure. In all patients, the average follow-up time was 25 months with a range of 4-66 months. Six patients (9 breasts) pre-operatively had Baker grade 4 capsular contracture. Post-operatively, there were no recurrences of capsular contracture, however average follow-up was only 21 months.
Conclusions - 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 and breast tissue repairs. It also appears effective in masking the hyperdynamic deformity seen with a laterally displaced pectoralis major muscle. Its high cost, however, may be a deterrent to widespread use in self-pay patients.
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