Correction of chest wall deformity after implant-based breast reconstruction using poly-l-lactic acid (Sculptra)

Implant-based breast reconstruction after mastectomy offers excellent cosmetic results in select individuals. However, this technique may result in a step-off between the implant and the soft tissue of the chest wall, which can be problematic in the extremely thin patient. Also, the removal of soft tissue can result in prominent ribs and visible intercostal spaces. A number of surgical options exist to correct these defects and include dermal grafts, flap reconstruction, and implant exchange. We present the case of a thin woman with a persistent "step-off" deformity and visible intercostal spaces after mastectomy and two-stage implant reconstruction. Placement of acellular cadaveric dermis (Alloderm) failed to improve the appearance of her chest wall. The authors utilized poly-l-lactic acid (Sculptra) for soft tissue augmentation of her chest wall with significant esthetic improvement. This novel use of poly-l-lactic acid offers a useful alternative to invasive surgical procedures to correct a soft tissue deformity of the chest wall. While poly-l-lactic acid has recently gained popularity for soft tissue augmentation of the face, to date, no reports in the literature exist describing its use in the correction of difficult chest wall defects after mastectomy and implant reconstruction. We maintain that poly-l-lactic acid may also be useful to improve a variety of soft tissue deformities of the breast.