Revision of the previously augmented breast is a challenge for plastic surgeons in Los Angeles and across the country, yet is a focus of my revisional practice. There are many reasons that women present to me for revision of their breasts, dissatisfied after having surgery elsewhere.
1) Rippling & Wrinkling-both palpable and visible
3) Implant Malposition (too high, too low, too lateral)
4) Inadequate or excessive muscle division with resultant hyperdynamic deformity.
I have used Human Acellular Dermal Matrix (i.e . Alloderm) for many years as an adjunct to surgical reconstruction in many areas of the body. Use of Alloderm in breast reconstruction has a proven track record. More recently, Alloderm (and Alloderm’s porcine equivalent, Strattice) have shown promise in revisional aesthetic breast surgery. Alloderm works very well to cover surface irregularities that may appear in thinner patients with little breast tissue over their implants. It also works well as a scaffold for repositioning critical breast landmarks (i.e. the inframammary fold) that have been altered during previous operations. A recent study (Plast. Recon. Surg.Vol 126, #5, Nov 2010) lends essential support to the safety and utility of Alloderm use in revisional cosmetic breast surgery.
Although Alloderm for correction of breast deformities is useful, there are potential downsides. The first and most apparent is the cost. Alloderm is quite expensive (several thousand dollars per sheet, depending on the size) and is frequently not covered by most health insurance plans. The second and equally important, is the small but finite risk of infection. Alloderm is a biological, avascular foreign body. Alloderm is an irradiated (to kill any living donor cells, bacteria and viruses) and freeze-dried dermal matrix, and although is prepared aseptically, it is not technically sterile.