title: Acellular dermal matrix for the treatment and prevention of implant-associated breast deformities.
abstract: BACKGROUND
  Acellular dermal matrix has been increasingly accepted in prosthetic breast reconstruction. Observed benefits include improved control and support of implant position, better implant coverage, and the suggestion of a decreased capsular contracture rate. Based on this positive experience, it is not surprising that acellular dermal matrix would be applied to other challenging implant-related problems. This study investigates the use of acellular dermal matrix for correction or prevention of implant-associated breast deformities.
  
  
  METHODS
  Patients who underwent primary aesthetic breast surgery or secondary aesthetic or reconstructive breast surgery using acellular dermal matrix and implants between November of 2003 and October of 2009 were reviewed retrospectively. Patient demographics, indications for acellular dermal matrix, and acellular dermal matrix type and inset pattern were identified. Preoperative and postoperative photographs, success or failure of the procedure, complications, and need for related or unrelated revision surgery were recorded.
  
  
  RESULTS
  Fifty-two patients had acellular dermal matrix placed alongside 77 breast prostheses, with a mean follow-up of 8.6 months (range, 0.4 to 30.4 months). Indications included prevention of implant bottoming-out (n = 6), treatment of malposition (n = 32), rippling (n = 20), capsular contracture (n = 16), and skin flap deficiency (n = 16). Seventy-four breasts (96.1 percent) were managed successfully with acellular dermal matrix. Three failures consisted of one breast with bottoming-out following treatment of capsular contracture, one breast with major infection requiring device explantation, and one breast with recurrent rippling. There was a 9.1 percent total complication rate, consisting of three mild infections, one major infection necessitating explantation, one hematoma, and one seroma.
  
  
  CONCLUSIONS
  Based on this experience in 77 breasts, acellular dermal matrix has shown promise in treating and preventing capsular contracture, rippling, implant malposition, and soft-tissue thinning.
authors.affiliation: Washington, D.C.; and Los Angeles, Calif. From the Department of Plastic Surgery, Georgetown University Hospital, and the David Geffen School of Medicine at the University of California, Los Angeles.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Spear
authors.forename: Mitchel
authors.initials: M
authors.lastname: Seruya
authors.forename: Mark W
authors.initials: MW
authors.lastname: Clemens
authors.forename: Steven
authors.initials: S
authors.lastname: Teitelbaum
authors.forename: Maurice Y
authors.initials: MY
authors.lastname: Nahabedian
mesh_terms: D000328:Adult; D000368:Aged; D018427:Breast Implants / Q000009:adverse effects*; D003094:Collagen; D020405:Dermis / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D015625:Tissue Expansion Devices; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003094:Collagen