Breast Dermal Grafting :: A Way to Achieve Both Natural Results and Stability Instead of Implants

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• Breast dermal grafting: a way to achieve both natural results and stability -

“ I want breast surgery, but implants feel uncomfortable or scary.”

“I heard fat grafting doesn’t last long. Is there an alternative?”

These are the concerns I hear most often in consultations. As a plastic surgeon with more than 17 years of clinical experience, I understand better than anyone the feelings of patients who want both safety and natural results.

Although many people are curious about breast dermal grafting, the available information is not as widely known as it is for standard silicone implants, so today I’ll give you an overall overview of breast dermal grafting, which many people ask about.

What is breast dermal grafting?

Breast dermal grafting is a method that uses dermal tissue harvested from your own skin or acellular dermal matrix (ADM) provided by a human tissue bank (such as AlloDerm, MegaDerm, etc.) as a reinforcing layer over or under an implant, or in a fat grafting area, or used on its own.

In simple terms, you can think of it as a “protective layer that wraps around an implant or fat,” or something that “functions as an implant on its own.”

It is especially meaningful when the skin is thin or when the tissue has become weak due to revision surgery. It can also be a new option for people who want fat grafting but do not have enough fat available.

How does it work?

When the skin is thin and the outline of an implant becomes visible, adding a dermal layer can help reduce the awkwardness of the boundary.

In breast revision surgery, when the skin and tissue have been damaged, it reinforces the thinned skin around the implant and helps improve safety.

In general, the survival rate of fat grafting is known to average around 34% to 82%, with wide variation depending on the individual and the technique. Evidence that acellular dermal matrix (ADM) directly increases fat graft survival is limited, but by adding thickness to thinner areas, it can help support contour stability and fat retention.

For people who want fat grafting instead of implant insertion but do not have enough fat to harvest, it can be an alternative to both implants and fat.

In addition, when used together with implants, it is known to help prevent and correct capsular contracture. There are studies showing that ADM helps improve implant stability in cases such as capsular contracture and double-bubble deformity.

What are the characteristics of breast dermal grafting based on my experience?

1. Reduced foreign-body sensation

Unlike implants, it blends naturally with our tissue and has the advantage of causing less foreign-body sensation.

2. Enhanced stability

It acts as a kind of “reinforcement material” and helps reduce complications caused by implant displacement or thinning skin.

3. Helpful in revision surgery

When there is thin skin, scar tissue, or contracture problems, it can be an alternative that improves stability.

Source: Merry Plastic Surgery Clinic blog

One patient complained that, after the first surgery more than 10 years ago, the implant outline was prominent and the feel was firm. After consultation, we removed the implant and performed revision surgery using breast dermis, and after recovery the feel became much more natural.

Another patient was worried that fat grafting alone would not maintain the desired volume. By applying fat grafting together with dermal reinforcement, the results were stable.

Then

Dermal grafting is a method with relatively well-established safety, but like other procedures, temporary swelling, bruising, and pain may occur after surgery. Also, according to a 2017 PRS review (including the Aesthetic Surgery Journal), the recurrence rate of contracture with ADM use in cosmetic revision surgery was reported to be as low as about 1.5%.

In other words, with proper patient selection and the surgeon’s skilled technique, it can be performed as a sufficiently safe operation.

Breast dermal grafting is recommended for people like this.

“I don’t want breasts that obviously look like implants. Is there a method other than implants?”

“I’m worried about contracture because my skin is thin.”

“I’m having revision surgery, and I’m worried because my skin has become weak.”

“I’d like the results of fat grafting to be maintained stably.”

In breast surgery, what matters is not simply size, but naturalness and stability. Dermal grafting is an important reinforcement method that can achieve both at the same time.

However, it does not apply equally to every patient, and a customized strategy is needed depending on individual skin thickness, body type, and surgical history. The most important thing is to find the method that is right for you through an accurate consultation.

If you have any questions, please leave them in the comments or send them through mutual subscription. Also, if you consult with a specialist at a nearby hospital, you can get safer and more specific answers.

References

Headon H, Kasem A, Mokbel K. The role of acellular dermal matrix in breast surgery. Int J Surg. 2016;36(Pt A):252–262. doi:10.1016/j.ijsu.2016.11.008

Macarios D, et al. Complications associated with acellular dermal matrices in breast surgery: a systematic review. Plast Reconstr Surg. 2017;139(5):998e–1008e.

Kim JY, et al. Use of acellular dermal matrix in aesthetic breast surgery. Arch Plast Surg. 2019;46(4):289–297.

Khavanin N, et al. Acellular dermal matrix for prevention of capsular contracture in implant-based breast surgery: A systematic review and meta-analysis. Aesthetic Surgery Journal. 2017;37(7):S62–S69.

Textbook of Breast Surgery (published by the Korean Society of Plastic and Reconstructive Surgeons, 2021).

This has been Merry Plastic Surgery Clinic.