I currently have tissue expanders. My surgeon will use alloderm to make a hammock during implant exchange. What are advantages & disadvantages of using Alloderm at this final stage? What effect will it have on my pectoral muscles? Will I see or feel a ridge along suture line once stitches have dissolved? Thank you
Advantages & Disadvantages to Alloderm Put in During Implant Exchange?
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AlloDerm and Strattice are safe and effective in breast reconstruction and revision breast augmentation
In my New York City plastic surgery practice, I have observed that if AlloDerm is used in breast reconstruction, it is usually placed immediately before tissue expanders are inserted. AlloDerm has more elasticity than Strattice which is advantageous when stretching the skin. It is available in a sterile manner (which was not always the case) and minimizes the amount of dissection that needs to be performed during surgery. Over time, AlloDerm and the sutures which secure it dissolve. No ridge should be apparent along the suture line once the sutures (stitches) have dissolved.
Alloderm during tissue expander to implant exchange
Most surgeons will use the alloderm during the first stage when the tissue expanders are placed to help add shape to the lower pole of the breast. It also results in less pain and easy expansion.
A new technique that some surgeons are now trying is to place a small sheet of strattice or alloderm during the tissue expander to implant exchange along the upper pole of the breast to reduce the risk of capsular contracture. I do not feel the benefits outweigh the risks on this. I have not seen issue s with ridging of the suture line with alloderm and find it has little effect on the pectoralis muscles.
I wish you a safe recovery and fantastic result.
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Alloderm during implant exchange
Alloderm is acellular dermal matrix that is usually used at the time of tissue expander placement. I routinely use Strattice (xenograft, another option); I think a dermal matrix allows a faster expansion and better shape. You should not feel any ridge or sutures. The dermal matrix will incorporate with your body. I don't know why Alloderm is being used for implant exchange stage...
Allograft / Alloderm and Breast Reconstruction
Alloderm is an acellular dermal matrix that is used for breast reconstruction most commonly but also revision breast augmentation to hide ripples or abdominal hernia repair. All allografts, as there are many, are human cadaveric skin which has been sterilized. Our bodies use the allograft as a scaffold in which to incorporate (grow into) new tissue. You can think of the allograft as a type of "skin graft". Allograft has been very well studied in breast cancer reconstruction and a few negatives are that its known to have a higher infection rate(~15% higher) and seroma rate (~10% higher) than traditional breast recon. (Seroma = collection of fluid) However the infection and seroma rates can be effectively lowered by good patient selection (non smoker, no diabetes, no obesity), and good surgical technique (good hydration of the allograft prior to placement, strict hemostasis, proper drain placement and time (typically 5-7 days), securing the allograft to the underside of the skin, and proper orientation of the allograft (there's an up and a down side)).
Even with the higher rate of inection and seroma I think the allograft is a valuable tool in the plastic surgeons ability to achieve a beautiful result.
You should not feel the suture line as long as the surgeon uses vicryl suture. Occationally surgeons use PDS which is like fishing line. Its possible to feel the knots if that type of suture is used. Allograft should have no lasting effect on your muscle. I believe that the cosmetic results of breast caner reconstruction using allografts in conjunction with a skin sparing mastectomy are superior.
Talk with your surgeon more about the risks and benefits that he/she perceives and how to mitigate them. I hope this helps.
Check out my page on breast reconstruction at mtpsaDOTcom I think it will help explain the process I use.
Advanages of Alloderm in breast reconstruction
Alloderm is an acellular dermal matrix that is tranformed into living tissue over time to form a sort of internal bra. This helps to support implants and allow for a better shape to the breast. There is evidence that it also helps to prevent capsular contracture, which is more common in reconstruction than in augmentation. The Alloderm is sewn to the pectoral muscle, so the muscle covers the upper part of the implant and the Alloderm the bottom part. You should not feel much of a ridge but it depends.
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