fig1 illustrates that a surgical attachment device 140 , such as a reinforcement or bridging patch , can be made from a biologic sheet , backing , matrix , or scaffold 200 , and one or more synthetic or other exogenous reinforcing longitude or longitudinal ( or radial ) leaders 10 a and / or lateral or latitudinal ( or angular ) leaders 10 b , such as polymer sutures , attached to the scaffold 200 . the leaders 10 can be inside and / or outside the material of the scaffold 200 . the device 140 can deliver a structural ( e . g ., biomechnical ) supporting force to surrounding tissue and / or implants . the scaffold 200 can a collagen sheet with cells removed or otherwise made animal tissue , such as an extracellular matrix ( ecm ) derived from the forestomach of a ruminant , such as a sheep . exemplary scaffolds are described in u . s . pat . no . 8 , 415 , 159 , which is incorporated by reference herein in its entirety . the scaffold 200 can have about 70 % or more , more narrowly about 80 % or more , for example 100 % of the cells , or from about 70 % to about 80 % of the cells removed or disrupted to remove the antigenic component of the disrupted cells . the scaffold 200 can be made from one of more ( e . g ., two , four , six , or eight ) layers of extracellular matrix . the scaffold and / or individual layers can have a thickness from about 1 mm to about 4 mm , for example about 1 . 8 mm . the scaffold and / or individual layers can also have a thickness from about 0 . 1 mm to about 0 . 2 mm . the layers can be bonded together . bonding may be accomplished by the use of biodegradable or non - biodegradable suture type materials , such as stitching by the leaders 10 , by tissue welding via rf frequency energy , biologic - type glues such as cyanoacrylate derivatives , fibrin / thrombin ; gelatins , gluteraldehydes ; or other artificial polymers or combinations thereof . the bonded areas may exist as discrete islands or as a single or multiple strips or areas of increased polymer or bonding content . the longitudinal leaders 10 a can intersect the latitudinal leaders 10 b at intersection angles 11 . the intersection angles 11 can be from about 5 ° to about 175 °, more narrowly from about 45 ° to about 135 °, for example about 90 °. the longitudinal leaders 10 a can be parallel or non - parallel with each other . the latitudinal leaders 10 b can be parallel or non - parallel with each other . the leaders 10 can be stitched into or through the scaffold 200 . the stiching can have stitch patterns with stitch lengths from about 1 mm to about 3 mm , for example about 1 . 5 mm . the longitudinal leaders 10 a can be spaced apart by a longitudinal leader gap 13 a from about 1 mm to about 25 mm , more narrowly from about 1 mm to about 12 mm , for example about 6 mm . the longitudinal leaders 10 a can be spaced apart by a longitudinal leader gap 13 a from about 1 mm to about 25 mm , more narrowly from about 1 mm to about 12 mm , for example about 6 mm . the leader gaps 13 can remain constant ( as shown in fig1 ) or vary ( as shown in fig5 ) across the length and / or width of the device 140 . the leaders 10 can be made from any of the materials disclosed herein or combinations thereof , such as a non - biodegrading polymer , such as polypropylene , ultra - high - molecular - weight polyethylene ( uhmwpe ), pet , ptfe , eptfe , or combinations thereof . the leaders 10 can be monofilaments or multifilaments . the leaders 10 and / or the filaments can have diameters from about 0 . 002 in . to about 0 . 02 in ., more narrowly from about 0 . 002 in . to about 0 . 01 in ., yet more narrowly from about 0 . 006 in . to about 0 . 008 in ., for example about 0 . 008 in . the longitudinal leaders 10 a can extend across 90 % or more , for example across the entire length , of the scaffold 200 and / or device 140 , for example extending from the bottom ( as seen in the figure relative to the page ) terminal edge to the top terminal edge . the lateral leaders 10 b can extend across 90 % or more , for example across the entire length , of the scaffold 200 and / or device 140 , for example extending from the left ( as seen in the figure relative to the page ) terminal edge to the right terminal edge . the device 140 can have a square or rectangular shape . fig2 illustrates that the device 140 can have a crescent shape . the crescent shape can have a left corner point or tip 18 a and a right corner point or tip 18 b . the device 140 can have a curved , convex distal edge 14 ( for attachment to a soft tissue , such as muscle away from the center of the body ) and a curved , concave proximal edge 16 ( for attachment to a bone and / or soft tissue , such as fascia or muscle closer to the center of the body than the distal edge 14 ). the device 140 can have longitudinal leaders 10 a , but no lateral leaders 10 b . the longitudinal leaders 10 a can extend from the distal edge 14 to the proximal edge 16 . the longitudinal leaders 10 b can radially extend from a common radial axis 12 . for example , all of the longitudinal leaders can radially extend from the same axis , or laterally symmetric pairs of longitudinal leaders 10 b can extend from common radial axes , such as the first radial axis 12 a and the second radial axis 12 b . the radial axis or axes 12 can be located not on or extending through the device 140 . the radial axis or axes 12 can be located distal of the distal edge 14 ( i . e ., with the longitudinal leaders 10 a extending apart from each other as they approach the proximal edge 16 ) or proximal of the proximal edge 16 ( i . e ., with the longitudinal leaders 10 a extending apart from each other as they approach the distal edge 14 ). the longitudinal leaders 10 a can extend in substantially straight ( as shown ) or curved directions , as viewed from above or below the device 140 . fig3 illustrates that the radial axis 12 can be located on and / or extend through the device 140 . the radial axis 12 can be located closer to the proximal edge 16 ( as shown ) distal edge 14 , or evenly between the two edges 14 and 16 . the radial axis 12 can be located laterally centered ( as shown ) to the device 14 or laterally off - center to the device 14 . fig4 illustrates that the device 140 can have latitudinal leaders 10 b , but no longitudinal leaders 10 b . the latitudinal leaders 10 b can extend around a common radial axis 12 along the entire length of the latitudinal leaders or at a given radius extending through the latitudinal leaders 10 b . the latitudinal leaders 10 b can extend in substantially straight or curved ( oval , as shown , but also can be circular ), as viewed from above or below the device 140 . fig5 illustrates that the crescent - shaped device 140 can have longitudinal and latitudinal leaders 10 a and 10 b . the device 140 can have the same or differing densities and / or quantities of longitudinal leaders 10 a compared to lateral leaders 10 b . fig6 illustrates that the distal edge 14 can be convex . the longitudinal leaders 10 a ( as shown ) and / or latitudinal leaders 10 b can have sinusoidal and / or zig - zag ( e . g ., z - shaped , w - shaped , and v - shaped ), as shown , stitching patterns . the leaders 10 can form right angles in the stitching patterns . the longitudinal leaders 10 b can be longer in the lateral center of the device 140 and shorter toward each of the lateral sides of the device 140 . longitudinal leaders 10 a and / or latitudinal leaders 10 b can terminate at the edges 14 and 16 or tips 18 ( as shown for the longitudinal leaders 10 a ), and / or terminate before the edges 14 and 16 or tips 18 , and / or can return to traverse the scaffold 200 without terminating at the edges 14 and 16 or tips 18 ( as shown for the latitudinal leaders 10 b ). fig7 illustrates that the device 140 can have reinforced anchors 20 at the tips 18 . the anchors 20 can be or have a higher concentration of polymer and / or thicker scaffolding ( e . g ., with more or thicker layers than the remainder of the device 140 ). for example , the anchors 20 can be or have polymer caps . the anchors 20 can be a significantly higher density ( e . g ., more than three times ) of leaders 10 than the density of leaders 10 in the remainder of the device 140 . the anchors can be formed by increasing the relative percent bonding content , by increasing the amount or layers of scaffold tissue matrix material , or combinations thereof . the anchors 20 can be over or embedded in the scaffold 200 . the anchors 20 can have smooth edges . during use , the device 140 can be inserted to the target site and attached to the target site solely with attachment elements , such as hooks , brads , staples , sutures , or combinations thereof , through the anchors 20 . fig8 illustrates that the anchors 20 can have irregular - shaped edges . for example , the edge of the anchors 20 attaching to the scaffold 200 can be pointed or spiky . the anchoring force load can be passively distributed across the edge of the anchor 20 to the scaffold 200 . fig9 illustrates that the anchor 20 can extend from left tip 18 a to the right tip 18 b along the proximal edge 16 ( as shown ) and / or the distal edge 14 . the anchor 20 can extend partially along one or both edges 14 and 16 without extending to one or both tips 18 . the anchors 20 can provide points for surgical attachment , provide areas of increased strength or thickness where increased stress is expected post operatively , aid in producing a post - surgical shape of the device 140 , or combinations thereof . fig1 illustrates that the device 140 can have one or more extension flaps or fillers 22 extending proximally from the proximal edge 16 ( as shown ) and / or distal edge 14 . the fillers 22 can be laterally symmetric ( as shown ) or asymmetric . the fillers 22 can be square , rectangular , circular , oval , or cut - off portions of those shapes . the fillers 22 can be extensions of the scaffold 200 or different material than the scaffold 200 . the fillers 22 can have the same , a thinner , or a thicker thickness than the scaffold 200 . fig1 illustrates that the device can have tabs , tethers , or tip extenders 24 extending in a distal direction from the distal edge 14 . the extenders 24 can be laterally symmetric ( as shown ) or asymmetric . the extenders 24 can be extensions of the scaffold 200 or different material than the scaffold 200 . the extenders 24 can have the same , a thinner , or a thicker thickness than the scaffold 200 . the fillers 22 and / or extenders 24 can be used for surgical attachment and / or manipulation . fig1 a illustrates that one or more of the leaders 10 ( the proximal - most latitudinal leader 10 b is shown ) can have both of its leader terminal ends 26 that can be loose and extend out of the scaffold 200 , for example in the direction of the distal edge 14 or proximal edge 16 ( as shown ). the leader terminal ends 26 can be pulled to tension the respective leader and cinch the device 140 ( e . g ., a “ purse string ” or “ shoe string ” effect ). fig1 b illustrates that a first latitudinal leader 10 b ′ can have a first leader terminal end 26 a that can extend out of the scaffold 200 at the right tip 18 b , and a second terminal end that can terminate in the scaffold 200 . a second latitudinal leader 10 b ″ can have a second leader terminal end 26 b that can extend out of the scaffold 200 at the left tip 18 a , and a second terminal end that can terminate in the scaffold 200 . the first latitudinal leader 10 b ′ can be the adjacent latitudinal leader to the second latitudinal leader 10 b ″. fig1 c illustrates that a first tensioning force , shown by arrow 28 a , can be applied to the first leader terminal end 26 a in the terminal direction of the first leader terminal end 26 a . a second tensioning force , shown by arrow 28 b , can be applied to the second leader terminal end 26 b in the terminal direction of the second leader terminal end 26 b . the tensioning forces 28 can cause the first and second latitudinal leaders 10 b ′ and 10 b ″ to deliver a cinching force , shown by arrows 30 , to the scaffold 200 adjacent to the respective leaders 10 b ′ and 10 b ″. fig1 illustrates that the device 140 and / or scaffold 200 can have round ( as shown ) or square pores 30 with pore diameters or widths from about from about 1 mm to about 12 mm , for example about 6 mm . one or more of the scaffold &# 39 ; s layers 32 , such as an inner layer 32 a , middle layer 32 b , and outer layer 32 c , can have pores 30 . the pores 30 can completely or partially align ( i . e ., be congruent ) between the layers 30 , for example creating an open channel and allowing fluid communication between the external sides or faces of the scaffold 200 . the pores 30 can be offset between the layers 32 forming a tortious or incomplete path between the external sides or faces of the scaffold 200 . tissue ingrowth ( i . e ., repopulation ) can pass through the pores 30 . biological or other fluids can pass through the pores 30 . for example , drainage through the pores 30 can decrease seroma formation . the pores 30 can be slits ( e . g ., wherein no material has been removed ), and / or holes ( e . g ., created by the removal of material ). fig1 a through 14 c illustrate that the scaffold 200 can have a scaffold first panel 220 and a scaffold second panel 221 . the scaffold first and second panels 220 and 221 can be bonded to each other along a seam or margin 230 . the device 140 can have a cupped or bowled shape with a cavity . any or all elements of the device 140 and / or other devices or apparatuses described herein can be made from , for example , a single or multiple stainless steel alloys , nickel titanium alloys ( e . g ., nitinol ), cobalt - chrome alloys ( e . g ., elgiloy ® from elgin specialty metals , elgin , ill . ; conichrome ® from carpenter metals corp ., wyomissing , pa . ), nickel - cobalt alloys ( e . g ., mp35n ® from magellan industrial trading company , inc ., westport , conn . ), molybdenum alloys ( e . g ., molybdenum tzm alloy , for example as disclosed in international pub . no . wo 03 / 082363 a2 , published 9 oct . 2003 , which is herein incorporated by reference in its entirety ), tungsten - rhenium alloys , for example , as disclosed in international pub . no . wo 03 / 082363 , polymers such as polyethylene teraphathalate ( pet ), polyester ( e . g ., dacron ® from e . i . du pont de nemours and company , wilmington , del . ), poly ester amide ( pea ), polypropylene , aromatic polyesters , such as liquid crystal polymers ( e . g ., vectran , from kuraray co ., ltd ., tokyo , japan ), ultra - high molecular weight polyethylene ( i . e ., extended chain , high - modulus or high - performance polyethylene ) fiber and / or yarn ( e . g ., spectra ® fiber and spectra ® guard , from honeywell international , inc ., morris township , nj , or dyneema ® from royal dsm n . v ., heerlen , the netherlands ), polytetrafluoroethylene ( ptfe ), expanded ptfe ( eptfe ), polyether ketone ( pek ), polyether ether ketone ( peek ), poly ether ketone ketone ( pekk ) ( also poly aryl ether ketone ketone ), nylon , polyether - block co - polyamide polymers ( e . g ., pebax ® from atofina , paris , france ), aliphatic polyether polyurethanes ( e . g ., tecoflex ® from thermedics polymer products , wilmington , mass . ), polyvinyl chloride ( pvc ), polyurethane , thermoplastic , fluorinated ethylene propylene ( fep ), absorbable or resorbable polymers such as polyglycolic acid ( pga ), poly - l - glycolic acid ( plga ), polylactic acid ( pla ), poly - l - lactic acid ( plla ), polycaprolactone ( pcl ), polyethyl acrylate ( pea ), polydioxanone ( pds ), and pseudo - polyamino tyrosine - based acids , extruded collagen , silicone , zinc , echogenic , radioactive , radiopaque materials , a biomaterial ( e . g ., cadaver tissue , collagen , allograft , autograft , xenograft , bone cement , morselized bone , osteogenic powder , beads of bone ) any of the other materials listed herein or combinations thereof . examples of radiopaque materials are barium sulfate , zinc oxide , titanium , stainless steel , nickel - titanium alloys , tantalum and gold . the device 140 can be made from substantially 100 % peek , substantially 100 % titanium or titanium alloy , or combinations thereof . any or all elements of the device 140 and / or other devices or apparatuses described herein , can be , have , and / or be completely or partially coated with agents for cell ingrowth . the device 140 and / or elements of the device and / or other devices or apparatuses described herein can be filled , coated , layered and / or otherwise made with and / or from cements , fillers , and / or glues known to one having ordinary skill in the art and / or a therapeutic and / or diagnostic agent . any of these cements and / or fillers and / or glues can be osteogenic and osteoinductive growth factors . examples of such cements and / or fillers includes bone chips , demineralized bone matrix ( dbm ), calcium sulfate , coralline hydroxyapatite , biocoral , tricalcium phosphate , calcium phosphate , polymethyl methacrylate ( pmma ), biodegradable ceramics , bioactive glasses , hyaluronic acid , lactoferrin , bone morphogenic proteins ( bmps ) such as recombinant human bone morphogenetic proteins ( rhbmps ), other materials described herein , or combinations thereof . the agents within these matrices can include any agent disclosed herein or combinations thereof , including radioactive materials ; radiopaque materials ; cytogenic agents ; cytotoxic agents ; cytostatic agents ; thrombogenic agents , for example polyurethane , cellulose acetate polymer mixed with bismuth trioxide , and ethylene vinyl alcohol ; lubricious , hydrophilic materials ; phosphor cholene ; anti - inflammatory agents , for example non - steroidal anti - inflammatories ( nsaids ) such as cyclooxygenase - 1 ( cox - 1 ) inhibitors ( e . g ., acetylsalicylic acid , for example aspirin ® from bayer ag , leverkusen , germany ; ibuprofen , for example advil ® from wyeth , collegeville , pa . ; indomethacin ; mefenamic acid ), cox - 2 inhibitors ( e . g ., vioxx ® from merck & amp ; co ., inc ., whitehouse station , nj ; celebrex ® from pharmacia corp ., peapack , n . j . ; cox - 1 inhibitors ); immunosuppressive agents , for example sirolimus ( rapamune ®, from wyeth , collegeville , pa . ), or matrix metalloproteinase ( mmp ) inhibitors ( e . g ., tetracycline and tetracycline derivatives ) that act early within the pathways of an inflammatory response . examples of other agents are provided in walton et al , inhibition of prostoglandin e 2 synthesis in abdominal aortic aneurysms , circulation , jul . 6 , 1999 , 48 - 54 ; tambiah et al , provocation of experimental aortic inflammation mediators and chlamydia pneumoniae , brit . j . surgery 88 ( 7 ), 935 - 940 ; franklin et al , uptake of tetracycline by aortic aneurysm wall and its effect on inflammation and proteolysis , brit . j . surgery 86 ( 6 ), 771 - 775 ; xu et al , sp1 increases expression of cyclooxygenase - 2 in hypoxic vascular endothelium , j . biological chemistry 275 ( 32 ) 24583 - 24589 ; and pyo et al , targeted gene disruption of matrix metalloproteinase - 9 ( gelatinase b ) suppresses development of experimental abdominal aortic aneurysms , j . clinical investigation 105 ( 11 ), 1641 - 1649 which are all incorporated by reference in their entireties . fig1 and 16 illustrate that during manufacturing of the device 140 , the scaffold 200 can be stitched with the leaders 10 in desired patterns . the scaffold 200 and stitching of the leaders 10 can extend beyond the dimensions of the desired device 140 . the device 140 can then be cut ( e . g ., die cut or laser cut ) out of the scaffold 200 and stitching of leaders 10 . for example , fig1 shows a variation for making the device 140 of fig1 before the device 140 is cut from the scaffold 200 . a die in the shape of the device 140 can cut the device 140 from the scaffold 200 . excess length of the longitudinal stiches 10 a and scaffold 200 past both longitudinal ends of the device 140 can be cut away by the die . similarly , fig1 shows a variation for making a device 140 similar to the device 140 shown in fig6 . excess length of the scaffold 200 and the longitudinal and lateral leaders 10 a and 10 b can be cut away from all sides of the device 140 . fig1 a through 17 c illustrate that a first biologic matrix panel 220 can have a first edge or margin 230 a . a second biological matrix panel 221 can have a second edge or margin 230 b . the first biological matrix panel 220 can be bonded to the second biological matrix panel 221 along the margins 230 . bonding may comprise any of the methods described within this application . following the bonding , the device 140 can be in a desired three - dimensional shape and curvature , shown by the device 140 in fig1 a through 14 c . the degree of curvature of the cup of the device 140 can be tailored for an individual patient by varying the shape of the bonding margins . the device 140 can have complex anatomical shapes . two devices 140 can be made with symmetric or mirrored shapes ( e . g ., to be used on opposite breasts on the same patient ). the device 140 can be symmetric about a central axis in any of the three orthogonal dimensions . the panels 220 and 221 can be cut before or after the bonding to the desired shapes . the device 140 can be used , for example , during breast reconstruction or augmentation surgeries . the device 140 can physically support , and provide surgical manipulation and control of an associated breast implant . fig1 illustrates that the surgical attachment device 140 can support a liquid - filled prosthetic implant 120 placed under the pectoralis major muscle 100 following a mastectomy procedure . the device 140 can take the shape of the overlying prosthetic implant 120 , supporting the implant 120 and maintaining the desired contour of the breast reconstruction . after the implant 120 is inserted into the patient , the proximal edge 16 can be inserted and attached to the chest wall . the distal edge 14 can be attached to the pectoralis major . the tips 18 can be attached to soft or hard tissue adjacent to the lateral sides of the breast implant 120 . the tips 18 can be the only attachment points or attached to tissue in conjunction with the distal and / or proximal edges 14 and / or 16 . attachment of the device 140 to tissue can be via sutures , staples , brads , hooks , or combinations thereof . fig1 illustrates that the lower margin of the device 140 can lend additional support and shape by the nature of a curved shape or engineered curvature , which serves to approximate and define the reconstructed inframammary fold . the engineered curvature can include curving in three - dimensions . the engineered curvature can approximate the breast implant , inframammary fold and desired appearance of the reconstructed breast . the engineered curve can eliminate creases or folds which would be present when using a flat sheet for the same purpose . by eliminating such folds and creases the breast implant takes on a more natural contour with minimal distortions . the leaders 10 and leader patterns can impart anisotropic properties to the device 140 . the device 140 can have an initial modulus of elasticity ( or rate of length change relative to force applied , for example in the longitudinal direction ) when initially implanted and attached to tissue . this modulus ( or rate of length change relative to force applied ) can be substantially identical to that of the scaffold 200 . after time elapses , the scaffold 200 can stretch , for example in the longitudinal direction , due to force loads ( e . g ., supporting a breast implant ), whereby the leaders 10 can begin to strain and deliver a resistive force through the device 140 not substantially delivered at the time of the initial implantation and attachment . any elements described herein as singular can be pluralized ( i . e ., anything described as “ one ” can be more than one ). any species element of a genus element can have the characteristics or elements of any other species element of that genus . the above - described configurations , elements or complete assemblies and methods and their elements for carrying out the disclosure , and variations of aspects of the disclosure can be combined and modified with each other in any combination .
a hybrid medical device that can aid in reconstructive or augmentative surgery of the breast is disclosed . the device can utilize a suitable biological collagen tissue matrix combined with a synthetic material , for example , that can impart a high initial strength to the repair site while permitting proper healing and revitalization of the implanted device .