title: Pocket conversion made easy: a simple technique using alloderm to convert subglandular breast implants to the dual-plane position.
abstract: BACKGROUND
  The advantages of dual-plane, partially submuscular breast implants are well documented. Standard conversion techniques to dual-plane positioning use marionette sutures and internal capsulorrhaphy sutures from the lower edge of the pectoralis major muscle to the anterior capsule or breast fascia within the subglandular plane. These techniques are limited by high rates of postoperative implant malposition and technical limitations that make combined mastopexy procedures difficult to perform.
  
  
  OBJECTIVE
  We describe a simple technique familiar to most plastic surgeons accustomed to placing tissue expanders for use in breast reconstruction using Alloderm (LifeCell Corp., Branchburg, NJ) as a sling beneath the pectoralis major muscle to the chest wall.
  
  
  METHODS
  We studied 25 women who underwent breast augmentation revision from the subglandular to the dual-plane position by performing a 9-year retrospective review from 1999 to 2007 of 2 surgeons' experience. We identified 10 women for whom Alloderm, sutured from the lower edge of the pectoralis major muscle to the chest wall, was used to create a composite pectoralis-Alloderm pocket for partial submuscular transfer of implants and 15 case controls who underwent pocket conversion using standard capsulorrhaphy and marionette suture techniques.
  
  
  RESULTS
  The principal outcome variable of at least 1 complication was 73.3% without Alloderm, resulting in a 40% need for revision surgery, versus 0% with Alloderm (Fisher exact test; P < .05).
  
  
  CONCLUSIONS
  The standard techniques available for conversion of subglandular breast implants to the dual-plane position using capsulorrhaphy and marionette sutures are limited by a high complication rate for the reliable positioning into a stable dual-plane pocket during implant exchange. A commonly used technique in reconstructive breast surgery using Alloderm is shown to reliably convert subglandular implants to the dual-plane position.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of California-San Diego School of Medicine, San Diego, CA, USA. drmofid@mofidplasticsurgery.com
authors.forename: M Mark
authors.initials: MM
authors.lastname: Mofid
authors.forename: Navin K
authors.initials: NK
authors.lastname: Singh
mesh_terms: D000328:Adult; D001672:Biocompatible Materials / Q000627:therapeutic use*; D018427:Breast Implants; D016022:Case-Control Studies; D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: C440568:Alloderm; D001672:Biocompatible Materials; D003094:Collagen