What is MesoBioMatrix® commonly used for?
The world of breast augmentation has seen a remarkable evolution over the last 20 years. For example, the introduction and distribution of the cohesive gel silicone breast implants literally revolutionized the field of breast augmentation by improving implant reliability and durability while simultaneously maintaining the ability to enhance breast appearance. It also marked a quantum leap forward in the feel of breast implants, as silicone provides a markedly natural feel as compared to saline implants. Similar to the impact of silicone breast implants, the introduction of Meso Biomatrix® Acellular Dermal Matrix, has revolutionized the fields of breast augmentation, and as well, the field of breast implant revision. Dr. Durkin was first introduced to biologic mesh in 2011, and has incorporated its use into different facets of his aesthetic breast services.
Bottoming out breast implants-
When the implant migrates too low on the chest, and begins to lie on the upper abdomen, it usually is because the internal support system of the breast is too weak to support the implant, or because the lamella itself was damaged during implant placement. In this scenario, Belladerm® is a natural solution as it provides a strong support structure to the lower pole of the breast, allowing Dr. Durkin to elevate the implant into its natural, native position. By providing a strong foundational support to your implant, we can not only improve implant position, but maintain that position over a longer period of time because of the increased structural support offered by the mesh. These revisions are commonly undertaken through the previous breast augmentation incisions only, and no further incisions are usually required. Recovery is usually 7-10 days in length.
Moving implants from above the muscle to below the muscle –
Many women with implants placed above the muscle will develop descent of the breast mound as time goes on. We refer to this as “pseudoptosis”. In this scenario, the nipple position is well aligned with the breast implant, but the entire position of the breast is too low. The most effective solution for elevating the breast itself is to reposition the implants in a submuscular plane, and then use Belladerm® to maintain the implant below the muscle. This will markedly elevate the breast position relative to the chest and abdomen, yielding excellent upper pole fullness and cleavage, especially when combined with high and ultra-high profile implants. Many of these patients will also require a lift procedure to elevate the nipple-areolar complex to the new breast position. Recovery is usually 10-14 days in length.
Synmastia – When patients develop communication between the implant cavities, and the breast extends across the midline, we call this synmastia. This uncommon presentation requires a re-establishment of the barrier between the two breast mounds. Traditional methods have relied upon suture techniques only. With the advent of Belladerm®, we are now able to place a strong support system between the breast mounds, allowing for a much more durable and reliable repair. While this particular problem is very uncommon, repair of synmastia can be very difficult. The use of Belladerm® for synmastia has markedly improved repair durability, and the aesthetic quality of our results at Ocean Drive Plastic Surgery. We recommend use of Belladerm® in all cases of synmastia. Most repairs are done through the original breast augmentation incision, and lift procedures are usually un-necessary. Recovery is typically 7-10 days.
Implant is in the armpit-
When patients develop lateral migration of their implants, we commonly use Meso BioMatrix® to recentralize the breast implant. This is a very common request in our practice, as over time, almost all implants migrate laterally, regardless of whether they are placed above or below the muscle. With lateral support placement, many patients are able to simultaneous downsize their implant while improving their overall cleavage and upper pole fullness. This occurs because the Meso BioMatrix ® reduces the breast cavity side diameter, allowing the implant to settle in a more medial and superior position. This repair is usually done through the original breast augmentation incision, and requires 7-10 days recovery.
We approach capsular contracture very aggressively at our institution, as it is one of the more common problems that we treat. We have found that Meso BioMatrix ® is very effective in re-creating natural breast aesthetics in cases where contracture has altered the overall breast shape. Also, it appears that use of acellular dermal matrices (biologic meshes) may reduce the recurrence rate of contracture. We strongly recommend use of Meso BioMatrix ® in cases of contracture, as we have anecdotally seen a marked reduction in re-contracture in patients with Meso BioMatrix ®.
Breast Augmentation with Lift-
For patients who want the best possible chance for outstanding and durable results following breast lift with implants, Meso BioMatrix ® is a natural choice. Dr. Durkin’s technique at Ocean Drive Plastic Surgery was designed to maximize upper pole fullness and cleavage without altering the natural breast shape. In these cases, we pro-actively support the lateral and inferior poles of the breast with the mesh, allowing us to maximize lift and projection. Use of the mesh can be done with any lift incision (around the nipple only, lollipop, or anchor). This specific technique was developed and published by Dr. Durkin, and is one of our more commonly requested procedures.
Fitness Models and Athletes-
The use of biologic mesh has markedly improved breast augmentation outcomes in fitness competitors. At Ocean Drive Plastic Surgery, we proudly boast a very large experience with fitness competitors and breast augmentation. We have even been published nationally on this issue! Most fitness models and competitors that we see are looking to maximize cleavage and fullness, but they are absolutely unwilling to change the functionality of their chest musculature. This is one of the critical differences between athletes and non-athletes. In the athlete category, extreme care must be taken to ensure that the breast implant dimensions do not exceed to dimensions of the pectoralis major muscle. Also, every attempt to maintain fascial support to the lower and lateral poles must be made. For women who are engaging in high intensity training three times a week or more, support is the critical factor. You must maintain, or improve overall support for the athlete receiving breast augmentation. The good news is that most athletes have a robust layer of fascia, and this plane can be used to great effect during implant placement. However, many women, especially those in the fitness modeling world want to support their breast implant as much as possible, and Meso BioMatrix ® offers, in our opinion, the safest and most durable result available. Meso BioMatrix ® is very effective in this specific patient population. Our experience with this patient population is very extensive, and some of our best results have occurred when we are able to use Meso BioMatrix in primary augmentations in fitness models and competitors.
Large sized breast augmentations- For women that want the proverbial “over the top” look, there are two options: 1) Use a custom breast implant over 800cc’s in size or 2) Use non-custom breast implants with improved inferior and lateral support. Of the two options, improving inferior and lateral support offers a much more functional and anatomic solution. We routinely use Meso BioMatrix ® for women who are looking for the “wow the crowd” result.
Are there any alternatives to Meso BioMatrix?
Yes. The most common one used is called Strattice®. Dr. Durkin avidly used Strattice from 2009-2012, but then switched over to Meso BioMatrix. Strattice is porcine based skin, meaning it is derived from a deceased pig. It is FDA approved for use in humans, and it is an effective product. Cost of the two grafts is comparable, but we prefer to use Meso BioMatrix ® because it is thinner, stronger, and it has a quicker integration time than its porcine skin. The quicker the graft integrates, the faster the patient recovery. As such, we believe that Belladerm® offers the same result as Strattice, but with a safer and quicker degree of graft integration.
There are other acellular dermal matrices available, such as Alloderm, Allomax, and Seri®. These specific brands are directed more towards breast reconstruction following cancer surgery rather than aesthetic plastic surgery, and we do not offer them to our cosmetic breast patients at this time.
Why doesn’t everyone use Meso BioMatrix?
Cost. Meso BioMatrix ® is very pricey. The smallest size starts at $4000 per patient.