Strattice Use for Reconstruction Surgery
Strattice™ Description Strattice™ Reconstructive Tissue Matrix (Strattice™ TM) is a surgical mesh that is derived from porcine skin and is processed and preserved in a patented phosphate buffered aqueous solution containing matrix stabilizers. It is derived from porcine dermis (pig skin), which undergoes non-damaging proprietary processing that removes cells and allows for early white cell migration, cell repopulation and rapid, revascularization.
Avoiding Complications During Reconstruction Surgery
TIGR Matrix Surgical Mesh Description Approved by the FDA in 2010, TIGR Matrix is the world’s first long-term resorbable biosynthetic mesh product. TIGR Matrix surgical mesh is primarily used to reinforce soft tissue where weakness exists. The mesh technology has a high strength for the first 6 months after implantation, and is completely degraded and resorbed after approximately 3 years. TIGR Matrix surgical mesh is being used to help aid correction of breast implant complications such as bottoming-out, capsular contracture, implant repositioning, breast asymmetry, lateral displacement, unnatural implant movement, and more. TIGR Matrix surgical mesh is clinically safe with very low complication rates. The mesh has proven to allow easy handling and fixation while being strong, flexible and affordable. Through the use of the TIGR Matrix surgical mesh, Dr. Pousti is able to more effectively address challenges during such breast revisionary procedures for the benefit of the patient, providing greater chances of overall surgical success.
TIGR Matrix Surgical Mesh
After breast augmentation surgery excessive scar tissue may form around the breast implant which causes the breast implants to harden (similar to what a contracted muscle feels like). The cause of capsular contracture is unknown, but it is the most common complication with breast augmentation surgery. There are different grades of capsular contracture ranging from mild to severe. The rate of capsular contracture has decreased from 20-30 years ago when all breast implants were placed above the muscle (sub-glandular). By placing the breast implants below the muscle (sub-muscular), the rate of capsular contracture has significantly decreased. Also, it is said that massaging of the implants helps decrease the chance of capsular contracture. When a patient is believed to be developing capsular contracture or hardening of the breasts, they may be placed on a medication called Accolate. This is an asthma medication that has shown to improve capsular contracture in patients at an early stage.When a patient develops severe capsular contracture, the treatment would be to return to the operating room and perform a capsulectomy on the patient. There is a chance that the capsular contracture may return after the revisionary breast surgery. Strattice has been shown to help reduce the chances of encapsulation occurring again.
Breast Implant Rippling or Palpability
When a patient doesn’t have much breast tissue or body fat, they may experience palpability of the breast implants and possibly rippling of the breast implants. Although the breast implants are placed under the muscle (sub-muscular), the outer edge and cleavage areas are not covered by the muscle and these are the most common places where rippling is experienced. The rippling / palpability of the breast implant can be decreased by using silicone gel breast implants versus saline filled breast implants. Silicone gel breast implants are now FDA approved and give a softer, more natural feeling to the patient with little breast tissue. Strattice adds another layer between the implant and the skin which help prevent the chance of rippling or palpability from occurring. Breast Implant Malposition/Displacement
Bottoming Out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. It is the loss of internal implant support where implant placement with partial, or no, muscle coverage, allows slow downward migration of the implants. This is because support of the implant by the skin alone is not always enough to prevent downward migration of the implants. Also, over-dissection of implant pockets at the time of surgery may cause immediate bottoming out. This is corrected by “raising” the inframammary fold using internal sutures. This is done after careful measurements are made from the areola to the “new” inframammary fold. To add another layer of support, preventing the implant from migrating down, Strattice is placed under the implant.
Lateral Displacement of implants causes the implants to migrate laterally causing the nipple areola complex to appear closer together. The support of the implant by the skin alone is not always enough support to prevent lateral migration of the implants. To add another layer of support laterally, Strattice is placed on the sides of the breasts between the skin and the implant to help prevent lateral displacement.
One of the more common problems that patients are seeking Dr. Pousti’s help for is symmastia. Symmastia – commonly referred to as “bread-loafing” or “uni-boob”, occurs when two implants touch one another in the center of the chest. If the horizontal muscle that is connected to the sternum and goes across the implant is cut during surgery, then the implant can move toward the middle of the chest. Symmastia results from overly aggressive attempts to alter chest wall anatomy trying to increase cleavage in patients. This outcome is made worse by use of larger implants in thin patients, and is a problem for implants over or under the muscle, though sub muscular implant placement allows the muscle to provide some softening of the transition to the cleavage area from the augmented breast mound. Strattice is used to prevent medial displacement of implants by adding support to the skin and creating an additional layer between the implant and the medial pocket.
Support/Coverage for Breast Augmentation/Breast Lifting Patients
Strattice can be used to add an additional layer of support between the patients skin and the breast implant. Although the breast implants are placed under the muscle (sub-muscular), the outer edge and cleavage areas are not covered by the muscle, leaving them at risk for displacement. By adding the additional layer of Strattice, the implant is provided with more support and coverage.
After your consultation, if Dr. Pousti decides that Strattice, Strattice or TIGR Matrix would assist in your reconstruction, he will discuss the procedure in detail and go over all of the potential risks and complications associated with the procedure. AlloGraft can come in different sizes ands shapes. Dr. Pousti has used Strattice for several patients with wonderful results.
This patient has had trauma to the pectoral muscle and needed a large piece of Strattice for coverage.
Above is before Revisionary Surgery.
Above is days after Revisionary Surgery with Strattice.
Another patient needed to use Strattice to get better coverage due to the fact that the implant was very close to the surface.
Resumption Of Physical Activities: Driving may be resumed in 1-2 weeks. Non-contact sports in 3 weeks. Contact sports in 6 weeks.