Part II: Dermal Matrices in Breast Augmentation

6) Acellular Dermal Matrices for Secondary Augmentation

Some of the most complicated and challenging predicaments to correct are deformities of the breast following breast augmentation and augmentation mastopexy(breast lift). They are of the most complex procedures that a plastic surgeon may face with a significantly higher rate of complications compared to primary procedures, perhaps due to the fact that there may be encapsulation or stretch of breast tissue caused by excessive scarring or thinning attributed to the use of large implants.^23,35 In a 2 year study where 78 patients who underwent breast augmentation and augmentation mastopexies  with acellular dermal matrices were enrolled and followed up for 12 months, no capsular contractures were reported although, two complications did occur; implant malposition and hematoma formation. This data suggests that with the use of acellular dermal matrices the capsular contracture rate following revision breast augmentation and augmentation mastopexy procedures is markedly reduced. ³⁵ In a more recent retrospective study by Hartzell et al²³ a single surgeons’ experience using acellular dermal matrix  following breast augmentation from 2005 to 2009 was analyzed during which 23 patients (38 breasts) were included. Of the 38 breasts, implant malposition was reported in 22 and surface irregularities in 28, with both appearing in 12 patients. Following their revision procedure, 20 patients showed improvement in the aesthetic appearance of their breasts, 3 patients required an additional procedure and 1 patient was found to have incurred an infection for which the human acellular dermal matrix was removed. In the end, the authors proclaim the use of human acellular dermal matrix a safe alternative for correction of breast deformities following augmentation.