Breast Augmentation | Dr. Forley

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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

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

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

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

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 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 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.

Tags: bottoming out, Breast Augmentation, breast fold malposition, breast implants, breast lift, breast surgery, Capsular Contracture, mastopexy, Strattice, Symmastia
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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.

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

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

Tags: Breast Augmentation, breast implants, breast lift, Capsular Contracture, mastopexy, Strattice, Symmastia
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BREAST IMPLANT UPDATE: THE FDA HEARING

Saturday, October 1st, 2011

The General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee to the Food and Drug Administration (FDA) met in August 2011 to discuss and make recommendations on issues related to silicone-gel filled breast implants. Dr. William Maisel, chief scientist for the Food and Drug Administration’s Center for Devices, re-confirmed the FDA judgment that silicone-gel implants are safe and effective for their intended use in breast augmentation.

The FDA placed restrictions on the use of silicone-gel implants in 1992 due to concerns about a possible link to autoimmune disease such as rheumatoid arthritis and lupus. Clinical trials conducted over the next decade failed to show any evidence of an increased incidence of these conditions in women with breast implants. In November 2006, supported by scientific evidence, the FDA removed the 1992 restrictions on the use of silicone-gel implants made by Mentor and Allergan. As an additional safety measure, the FDA required companies to conduct decade-long studies of their implants’ performance. The FDA has also looked at the studies conducted to gain approval, which have longer and better follow-up than those launched after the 2006 decision. Other studies published in the scientific literature and reports of adverse events helped complete the picture, Maisel said.

When considering both current and future post approval study designs for silicone-gel implants, the panel discussed methodologies and strategies that could increase compliance with follow-up. As discussed in a number of questions about methods and data collection, the panel felt that a breast implant registry of all women who receive the device may provide a means to answering many of the longer term and real world questions, in particular the questions associated with rare adverse events.

The FDA and the Devices Panel consider MRI as the gold standard for evaluating breast implants for evaluation of rupture. However, a 2006 requirement for regular MRI follow up studies following breast augmentation was deemed by the panel to be expensive and unnecessary. Dr. Forley advises his patients to return for annual follow up exams. They are also encouraged to see Dr. Forley in the interim if there is any change in the appearance or feel of the breasts after surgery.

Tags: Breast Augmentation, Plastic Surgery
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THE OBESITY EPIDEMIC
HAND REJUVENATION
HEALING FOODS FOR SURGERY
PART 2: ENHANCING BREAST SURGERY RESULTS WITH STRATTICE™- CASE EXAMPLES
PART 1: ENHANCING BREAST SURGERY RESULTS WITH STRATTICE™

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