Porcine-derived acellular dermal matrix in primary augmentation mammoplasty to minimize implant-related complications and achieve an internal mastopexy: a case series

Andrew Kornstein

doi:10.1186/1752-1947-7-275

Abstract

IntroductionPatients who present for augmentation mammoplasty with poor quality mammary soft-tissue support may be at increased risk for post-operative complications. Non-crosslinked intact porcine-derived acellular dermal matrix (Strattice™ Reconstructive Tissue Matrix, LifeCell Corp., Branchburg, NJ, USA) may enhance soft-tissue support in such patients and reduce implant-related complications, including capsular contracture, rippling, palpability, and malposition. The objective of this case report series was to describe the outcomes of three patients with poor quality mammary soft-tissue support who underwent primary cosmetic breast augmentation with pre-emptive implantation of porcine-derived acellular dermal matrix.Case presentationCase 1 concerns a 40-year-old Caucasian woman with post-partum soft tissue laxity and grade II ptosis. Case 2 concerns a 30-year-old Caucasian woman with congenital soft-tissue laxity and grade I + ptosis. Case 3 concerns a 49-year-old Caucasian woman with post-partum and post-weight-loss-induced laxity and grade III ptosis. In all three of our patients, porcine-derived acellular dermal matrix was sutured to the chest wall along the infra-mammary and/or a neo-infra-mammary fold and then laid passively superiorly or sutured under tension to the breast parenchyma or caudal edge of the pectoralis major muscle. In cases 1 and 2, a modified internal mastopexy technique was performed. Suturing the porcine-derived acellular dermal matrix to the posterior aspect of the breast parenchyma and/or caudal pectoralis muscle under appropriate tension in conjunction with radial plication of the porcine-derived acellular dermal matrix created a snug ‘hand-in-glove’ pocket and resulted in only minimal peri-areolar scarring. Case 3 required a vertical scar mastopexy. During a mean of 18 months of follow-up, all three patients had positive outcomes and no complications (that is, infection, hematoma, seroma, rippling, malposition, or capsular contracture). The surgeon and patients were generally highly satisfied with the aesthetic outcome of the breasts.ConclusionsPre-emptive use of porcine-derived acellular dermal matrix may be beneficial in patients with primary augmentation with poor quality mammary soft-tissue support.

Highlights

Patients who present for augmentation mammoplasty with poor quality mammary soft-tissue support may be at increased risk for post-operative complications
Pre-emptive use of porcine-derived acellular dermal matrix may be beneficial in patients with primary augmentation with poor quality mammary soft-tissue support
The supportive quality of mammary soft tissue may be evaluated based on the presence/absence of striae, breast parenchymal thickness assessed by pinch at the upper and lower poles, ease of parenchymal distraction at the lower pole and areola, ease of digital displacement of the infra-mammary fold from the underlying chest wall, and change in breast-tissue configuration in the ‘diver’s position’ [6]

Summary

Conclusions

In three patients with poor quality mammary soft-tissue support due to a variety of factors, the pre-emptive use of PADM during primary breast augmentation may have contributed to positive outcomes, marked by minimal complications and high patient satisfaction. Additional follow-up of these and similar patients is planned, and will be reported to assess long-term outcomes. Consent Written informed consent was obtained from all three patients for publication of this case report and accompanying images. Copies of the written consents are available for review by the Editor-in-Chief of this journal. Competing interests The author declares that he has no competing interests. Authors’ contributions AK performed the surgeries for all patients in the case study series, performed all follow-up assessments, was a major contributor in writing the manuscript, and approved the final manuscript for submission

Introduction

Discussion

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