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Archive for March, 2012

PART 2: ENHANCING BREAST SURGERY RESULTS WITH STRATTICE™- CASE EXAMPLES

Thursday, March 29th, 2012

Many difficult problems that can occur with breast surgery have been helped with the introduction of Strattice™, a biologic tissue support layer or matrix used to reinforce weakened tissues and enhance natural tissue regeneration.

Bottoming Out

Bottoming Out

Copyright © 2009 – 2012 LifeCell Corporation.

A lengthened nipple-to-inframammary fold distance due to skin stretching after surgery, and the breast pocket dropping lower than desired, can result in the nipple appearing to sit too high on the breast. A droopy or sagging appearance is produced when the skin below the nipple looks stretched and disproportionate in relationship to the overall size of the breast size. By attaching the Strattice™ internally to the fold, and chest muscle, the breast can be positioned in the desired location to correct this problem.

Fold Malposition

Fold malposition is a condition in which the fold under or lateral to the breast fold has become displaced. These folds give the breasts definition and help maintain the shape and position of the breasts. During breast augmentation surgery, a pocket is carefully created under the breast tissue. Breast folds act as important markers for the surgeon when creating the pocket and help to determine the surgical outcome. Loss of skin

Fold Malposition

Copyright © 2009 – 2012 LifeCell Corporation.

elasticity or a breakdown of pocket boundaries can occur over time due to the aging process and gravity. The inframammary fold, lateral fold, or both may be affected. The breast pocket may drift to the outside of the chest or appear to have dropped and will no longer be in the original desired position. Dr. Forley may recommend the use of Strattice™ to redefine the fold location inferiorly or laterally. This will support and hold the breasts in the desired location and achieve breast symmetry.

Symmastia

The normal appearance of breasts features a natural space between the breasts, which is defined by a gentle fold, referred to as the medial fold. The medial fold separates the breasts, giving them shape, form, and what is often referred to as cleavage. Even if the breasts are naturally large in size or have been enhanced, a degree of separation helps to give each breast definition. Symmastia is a condition in which the breasts sit too close

Symmastia

Copyright © 2009 – 2012 LifeCell Corporation.

together or possibly even touch one another. It can occur following breast augmentation surgery if the breast pocket created was made slightly too large, the breasts have migrated out of their original position, or the fibrous tissue which creates the medial fold becomes weak or stretched. Strattice™ may be used to reinforce and support existing weak or inadequate tissue to restore the natural separation between the breasts.

Wrinkling and Rippling

Wrinkling and Rippling

Copyright © 2009 – 2012 LifeCell Corporation.

The quality of the skin that envelops the breast tissue significantly influences the shape and appearance of the breasts. There is natural and hereditary variation in the amount of elasticity and thickness of each person’s breast skin, which affects the overall appearance of the breasts. A rippled appearance may also occur if the breast augmentation pocket exceeds the optimum size needed to maintain the position of the breast implants. If the breasts migrate out of their original position because the breast pocket is too large, the appearance of rippling may occur on the breast skin where volume is deficient. Many women who have either minimal body fat or thin skin may experience this less than desirable condition, simply known as breast rippling and wrinkling, following breast augmentation surgery. Dr. Forley may consider reducing the size of the breast pocket and using Strattice™ to help provide additional support. Strattice™ is placed at the bottom of the breast to reinforce weak or inadequate tissue, which can help reduce the presence of wrinkles and ripples on the skin surface.

Capsular Contracture

Capsular Contracture

Capsular Contracture is an unpredictable condition that may occur when naturally forming scar tissue surrounding the breast implant continues to increase in thickness. As thickness increases, it squeezes the implant causing tightness, firmness, and changes in breast appearance. Capsular contracture may occur in one or both breasts and may vary in degree and severity. Discomfort and changes in breast appearance may require additional surgery. Some corrective surgical outcomes may include partial or complete removal of the capsular scar tissue. Strattice™ reinforces weakened and inadequate tissue, which can help Dr. Forley to support and position the breasts in the desired location while allowing re-establishment of natural boundaries.

Augmentation Mastopexy

Augmentation Mastopexy

Copyright © 2009 – 2012 LifeCell Corporation.

Augmentation mastopexy is a breast surgery procedure that enhances both the position and size of the breasts by adding volume with an implant and lifting the breast tissue that has sagged. Women who have lost a significant amount of weight, including those whose breast tissue has changed following childbirth and breastfeeding, are candidates for augmentation mastopexy.Thin, weakened  tissues that may be insufficient to support the bottom part of the breasts can be reinforced with the use of Strattice™. During augmentation mastopexy surgery, Dr. Forley creates incisions using standard surgical techniques and then sutures Strattice™ to the chest wall and pectoralis major muscle to reinforce the breast pocket and help to keep the chosen implant in position. Removal of excess tissue and lifting of the breast is performed after this initial procedure has been completed.

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PART 1: ENHANCING BREAST SURGERY RESULTS WITH STRATTICE™

Wednesday, March 21st, 2012

Revision procedures are sometimes required to improve the results of breast surgery or handle problems that might develop following surgery. Recent clinical evidence has demonstrated the value of using a biologic tissue support layer or matrix to reinforce weakened tissues and enhance natural tissue regeneration. Strattice™, a sterile sheet of porcine dermis from which the cells have been removed, is now being used by Dr. Forley to provide not only the reinforcement of thin, sagging tissues, but a scaffold-effect to support new cell growth. The long-term success of revision procedures of the breast has been enhanced with use of this technique.

ENHANCING BREAST SURGERY RESULTS WITH STRATTICE™

Copyright © 2009 – 2012 LifeCell Corporation

Clinical Uses for Strattice™

  • Reinforce the desired position of the breast
  • Redefine the location of the fold under the breast by providing support inferiorly or laterally
  • Correct complications that may occur after breast implant surgery, such as bottoming out, fold malposition, and symmastia
  • Minimize the need for the use of additional muscles to provide a supportive covering layer in the breast
  • Reinforce thin breast tissue when implant ripples and wrinkles are present
  • Correct capsular contracture or hardening of the breast after implant surgery
  • Aid in augmentation mastopexy to enable a stable, long term breast lift
BREAST SURGERY RESULTS WITH STRATTICE™

Copyright © 2009 – 2012 LifeCell Corporation

In Part 2, we discuss in more detail how Strattice™ has provided a way to handle each of these clinical situations.

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THE SAGGING BROW: NON-SURGICAL & SURGICAL OPTIONS

Friday, March 9th, 2012

Sagging of the brow and forehead can make you appear stern or tired with a smaller appearing eye. This appearance is heightened when frown wrinkles appear between the eyes and across the forehead. Choice of a non-surgical or surgical option for your brow is based both on the extent of the sagging and your need to limit downtime.

Non-Surgical

Ultherapy®

Before Ultherapy

Before Ultherapy

1 month after Ultherapy

1 month after Ultherapy

Ultherapy® uses ultrasound energy to safely lift the brow with focused sound waves that create targeted heating of the layers deep to the skin that sag due to the onset of diminished firmness and elasticity.

The deep support layer is tightened without skin disruption because the sound waves penetrate below the surface to produce contraction of the collagen. Following Ultherapy® of the brow, some changes are visible immediately with continued improvement occurring over 3-6 months. The treatment can take as little as 20-30 minutes and last up to 2 years. It can be combined with Botox® Cosmetic to further enhance the position of the brow.

BOTOX® Cosmetic

Before BOTOX

Before BOTOX

After BOTOX

After BOTOX

BOTOX® Cosmetic produces a selective decrease in the downward pull of the muscle around the eye so that the upward pull of the forehead muscle will lift the brow. Very precise injections are utilized to balance muscle activity to produce the desired result. The treatment is simple with only minimal discomfort, requires just a few minutes, and you can resume normal activities immediately. The results will be apparent in a range of 1-3 days. The duration of effect is between 4-6 months.

Surgical

Endoscopic Browlift

Before Endoscopic Browlift

An endoscopic browlift provides a more definitive long-term solution to the sagging brow using the latest in innovative surgical technology to provide a safe and speedy recovery. When the heavy tissue is lifted out of the upper eyelid the eye looks fresher, more open, and you appear more energetic. People will stop asking you if you are tired or angry. The procedure is performed under twilight anesthesia with small incisions concealed within the hairline and a special high intensity light and imaging instrument called an endoscope. The attachments of the brow to the underlying bone are released to permit the tissues to be lifted and stretched upward, providing the necessary lift to the brows and reduction of wrinkling. Your forehead area will feel tight for 48-72 hours. This sensation will gradually resolve over the next several days as the swelling decreases. Bruising fades within 5-10 days and can be reduced with the use of techniques described in a previous blog http://drforley.com/blog/reducing-the-risk-of-bruising-following-your-procedure/.

After Endoscopic Browlift

After Endoscopic Browlift

Lateral Browlift

Before Lateral brow sagging

Lateral brow sagging

After Lateral brow sagging

After Lateral Browlift

Early sagging of the brow can be treated with a more limited browlift via a single temporal scalp incision. The procedure creates a more youthful and rested appearance that looks very natural.

The lateral browlift is usually performed under local anesthesia and may be combined with upper eyelid surgery when upper eyelid skin excess and fat prominence is also present.

Dr. Forley will evaluate your brow during your consultation and discuss with you the best options for your individual needs.

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