The Woodlands AlloDerm doctors

I am assuming by scar tissue, you are referring to capsular contracture?   If indeed you have been diagnosed with capsular contracture, then there are several treatment options.

First, if this is your FIRST bout of scar tissue around your implant, I personally would not jump to AlloDerm. Rather, I would perform a total capsulectomy (removal of scar tissue) and place a new implant in a new virgin pocket (example, transitioning your new implant from the above the muscle position to under the muscle or dual place). I reserve the use of AlloDerm in recurrent capsular contracture cases where other more established/traditional techniques have failed. Now, your other question was on AlloDerm and its role with capsular contracture.

There is emerging data showing that AlloDerm may have a role in slowing down or preventing capsular contracture. In fact, I published a clinical paper on this very topic in December 2010 issue of our primary plastic surgery journal: Plastic and Reconstructive Surgery. However, even as an primary author of this study, it is still too premature to guarantee that ADMs prevent capsular contracture. But there is growing evidence support this claim.

Dr. Basu

Basu Plastic Surgery - Houston, TX

Plastic & Reconstructive Surgery: December 2010 - Volume 126 - Issue 6 - pp 1842-1847 doi: 10.1097/PRS.0b013e3181f44674 Breast: Original Articles Acellular Cadaveric Dermis Decreases the Inflammatory Response in Capsule Formation in Reconstructive Breast Surgery Basu, C. Bob M.D., M.P.H.; Leong, Mimi M.D., M.S.; Hicks, M. John M.D., Ph.D.

AbstractBackground: Acellular cadaveric dermis in implant-based breast reconstruction provides an alternative to total submuscular placement. To date, there has been no detailed in vivo human analysis of the histopathologic sequelae of acellular cadaveric dermis in implant-based breast reconstruction. Based on clinical observations, we hypothesize that acellular cadaveric dermis decreases the inflammatory response and foreign body reaction normally seen around breast implants.

Methods: Twenty patients underwent tissue expander reconstruction using the “dual-plane” acellular cadaveric dermis technique (AlloDerm). During implant exchange, intraoperative biopsy specimens were obtained of (1) biointegrated acellular cadaveric dermis and (2) native subpectoral capsule (internal control). Histopathologic analysis was performed. Masked biopsy specimens were scored semiquantitatively by an experienced histopathologist to reflect observed granulation tissue formation, vessel proliferation, chronic inflammatory changes, capsule fibrosis, fibroblast cellularity, and foreign body giant cell inflammatory reaction. Scores were analyzed statistically using the Wilcoxon signed rank test.

Results: Acellular cadaveric dermis (AlloDerm) had statistically diminished levels for all parameters compared with corresponding native breast capsules (p < 0.001).

Conclusions: This represents the first detailed histopathologic comparative analysis between biointegrated acellular cadaveric dermis and native capsules in implant-based breast reconstruction. These histopathologic findings suggest that certain properties intrinsic to acellular cadaveric dermis may limit capsule formation by diminishing inflammatory changes that initiate capsule formation. Further investigation is needed to determine whether acellular cadaveric dermis reduces the incidence of breast capsular contracture. 

Great question.  First, if this is your FIRST bout of scar tissue around your implant, I personally would not jump to AlloDerm.  Rather, I would perform a total capsulectomy (removal of scar tissue) and place a new implant in a new virgin pocket (example, transitioning your new implant from the above the muscle position to under the muscle or dual place).   I reserve the use of AlloDerm in recurrent capsular contracture cases where other more established/traditional techniques have failed. Now, your other question was on AlloDerm and its role with capsular contracture.

There is emerging data showing that AlloDerm may have a role in slowing down or preventing capsular contracture. In fact, I published a clinical paper on this very topic in December 2010 issue of our primary plastic surgery journal: Plastic and Reconstructive Surgery. However, even as an primary author of this study, it is still too premature to guarantee that ADMs prevent capsular contracture. But there is growing evidence support this claim. 

Dr. Basu

Basu Plastic Surgery - Houston, TX

Plastic & Reconstructive Surgery: December 2010 - Volume 126 - Issue 6 - pp 1842-1847 doi: 10.1097/PRS.0b013e3181f44674 Breast: Original Articles Acellular Cadaveric Dermis Decreases the Inflammatory Response in Capsule Formation in Reconstructive Breast Surgery Basu, C. Bob M.D., M.P.H.; Leong, Mimi M.D., M.S.; Hicks, M. John M.D., Ph.D.

AbstractBackground: Acellular cadaveric dermis in implant-based breast reconstruction provides an alternative to total submuscular placement. To date, there has been no detailed in vivo human analysis of the histopathologic sequelae of acellular cadaveric dermis in implant-based breast reconstruction. Based on clinical observations, we hypothesize that acellular cadaveric dermis decreases the inflammatory response and foreign body reaction normally seen around breast implants.

Methods: Twenty patients underwent tissue expander reconstruction using the “dual-plane” acellular cadaveric dermis technique (AlloDerm). During implant exchange, intraoperative biopsy specimens were obtained of (1) biointegrated acellular cadaveric dermis and (2) native subpectoral capsule (internal control). Histopathologic analysis was performed. Masked biopsy specimens were scored semiquantitatively by an experienced histopathologist to reflect observed granulation tissue formation, vessel proliferation, chronic inflammatory changes, capsule fibrosis, fibroblast cellularity, and foreign body giant cell inflammatory reaction. Scores were analyzed statistically using the Wilcoxon signed rank test.

Results: Acellular cadaveric dermis (AlloDerm) had statistically diminished levels for all parameters compared with corresponding native breast capsules (p < 0.001).

Conclusions: This represents the first detailed histopathologic comparative analysis between biointegrated acellular cadaveric dermis and native capsules in implant-based breast reconstruction. These histopathologic findings suggest that certain properties intrinsic to acellular cadaveric dermis may limit capsule formation by diminishing inflammatory changes that initiate capsule formation. Further investigation is needed to determine whether acellular cadaveric dermis reduces the incidence of breast capsular contracture.