Acellular Dermal Matrix in Cosmetic Breast Procedures and Capsular Contracture

M M Mofid

doi:10.1177/1090820x11418201

Abstract

Prevention and treatment of capsular contracture after breast augmentation is a controversial and oftentimes vexing problem. While there are traditional methods of addressing this condition, acellular dermal matrix materials offer a new and promising modality that is gaining momentum in the field of plastic surgery. In this article, the author examines the etiology and pathophysiology of capsular contracture and review the existing literature on acellular dermal matrix in breast surgery related to capsular contracture.

Highlights

In a study of 283 patients undergoing breast reconstruction over a six-year period by seven surgeons, the relative risk of major infection with acellular dermal matrix (ADM) products (8.2%) was found to be 12-fold greater, the risk of seroma formation (14.1%) fourfold greater, and the risk of mastectomy major skin flap necrosis (20.5%) fivefold greater than when a tissue expander or implant was placed without ADM.[25]
Biopsy studies and histological evaluation of human breast capsules at the time of implant exchange seem to confirm that granulated tissue formation, capsular fibrosis, fibroblast cellularity, and foreign-body giant cell inflammatory reactions are all decreased relative to controls when cadaveric ADM is employed.[41]
Numerous technique modifications in breast surgery have been reported to result in a substantial decrease in rates of pathologic CC

Summary

Introduction

Manufacturer-reported data of pathologic (Baker[1] Grade III or IV) CC rates with saline and silicone implants have ranged from 10% to 30% over a three- to five-year period.[2,3,4] Large clinical studies have documented long-term CC rates of up to 30% in primary breast augmentation.[5] In the setting of breast reconstruction, radiation therapy is a clear risk factor for CC, with a reported incidence of up to 73%.6-10 Meta-analyses of shell

Results

Conclusion