Alloderm for Breast Reconstruction?
- Asked by brynze in Philadelphia
- 4 years ago
This is being tauted widely as the best breast reconstruction procedure out there for women to get through this terrifying and tramatic experience.
Unfortunately, many doctors do NOT know how to do this procedure yet, hence it is not widely available leaving patients to not be able to have it as an option insurance-wise. I have never heard anyone say anything about Alloderm not being sterile and not wanting to put it near an implant. Can you please elaborate?
Alloderm is one of the allografts available. These are called acellular dermal matrix.
Alloderm, is a product made by life cell corporation. It is the first to popularize the product for breast reconstruction. This product is a cadaveric skin that has been treated to not cause rejection. The dermal collagen matrix is repopulated by the host's cells and integrated in the body. Alloderm is not truly sterile but It has been treated with antibiotics to be aseptic. There are other products on the market now. Some of them are sterile. These products have revolutionized the implant breast reconstruction. And have made the surgery much more successful. Any surgeon doing breast reconstruction routinely should offer these products and at least discuss the pros and cons with the patients.
AlloDerm is essentially cadaver skin minus any living cells. It is used as a scaffold through which a persons living cells can grow into. It has many uses, but, in use his in breast reconstruction. AlloDerm does not help in mastectomy recovery. It does however help in breast reconstruction. In this application, AlloDerm was used to cover the lower portion of an implant that spans from the lower border of the pectoralis muscle to the breast fold. Because AlloDerm is a foreign substance in can always get infected and as such your doctor and you need to pay close attention to the signs and symptoms. AlloDerm has also been used in nipple augmentation as well as augmentation of other body parts. Its efficacy is really not known in these realms because it is not common. Some providers may use AlloDerm for these applications but please note that its most widespread use is particularly in breast reconstruction as well as repair for abdominal wall hernias. Please speak with a board certified plastic surgeon if you have any specific concerns regarding your care.
Alloderm and Breast Reconstruction
Alloderm is an acellular dermal matrix that is used for breast reconstruction. Our bodies use the allograft as a scaffold in which to incorporate (grow into) new tissue. Alloderm has been very well studied in breast cancer reconstruction and is 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 reported rate of inection and seroma I have not seen this to be a problem. Alloderm has a long history of being safe in the body. It is my choice of allograft for reconstruction as the integration rate is superior to all other allografts. Meaning it becomes part of you very quickly. The other types of allografts use various chemical treatments which delay integration and may lead to infection and non integration.
I have invented a new tissue expander to help with all allograft reconstructions and reduce the chance of infection and reduce seroma formation.
I hope this helps.
Recent AlloDerm Reviews
Breast reconstruction, nipple reconstruction, breast cancer, DCIS, mastectomy, TUG flap, DIEP flap, Latissimus flap, fat graft i
You should see a breast reconstruction surgeon who is comfortable discussing all of you options. The material is not difficult to use. it is most commonly used in expander/implant reconstruction or direct implant reconstruction.
Alloderm is an important tool that breast reconstructive surgeons use, and like
there are times when it is an extremely important part of the reconstruction, and other times when it is not necessary. Basically, alloderm is an acellualr dermal matrix, harvesteded from the underside of human skin and, after the cells are removed, prepared for use in patients. It can be extremely helpful in breast reconstruction with both expanders and implants, making the reconstruction quicker and easier, and often improving the appearance of the reconstructed breast. When used with expanders, it can quicken the time to expansion and help guide the vector of expansion for ptimum results. It can also allow us to perform immediate reconstruction with implants in select patients, thus avoiding an entire operation to remove the expander and replace it with a permanent implant. It also can help us place the implant along the exact inframamamry fold, improving the appearance of the breast.
Web reference: http://www.plasticsurgeryweb.com
Alloderm for Reconstruction
You are correct that not many surgeon's understand the use of the AlloDerm product. It is very important to do your research and chose a surgeon who has worked with this product before. There are many factors related with reconstruction of the breast - please make sure you are seeing an experienced board certified plastic surgeon to assist you.
Web reference: http://www.poustiplasticsurgery.com/alloderm.htm
Better breast reconstructions with Alloderm
AlloDerm product is human donor skin that has been treated to not cause rejection, leaving only a dermal collagen matrix. The dermal collagen matrix is incorporated by the hosts own body tissues. It has significantly improved results in breast reconstruction and also in complex aesthetic cases with recurrent intractable capsular contractures.
Alloderm and breast reconstruction
The "best" breast reconstruction depends on many variables, including patient breast size, unilateral or bilateral reconstruction, patient body habitus and history of radiation. In terms of tissue expander/implant reconstruction, using alloderm is not necessarily better than not using it. As a plastic surgeon that offers both options, I can tell you that there have been studies in our main journal that have shown no difference in cosmetic outcome for tissue expander/implant reconstruciton with and without alloderm. I prefer to use alloderm in a one - stage reconstruction. If more than one - stage is needed, then the advantage decreases.
Alloderm in Expander Breast Reconstruction
When placing an expander for breast reconstruction, I universally use Alloderm (or other human-derived dermal matrix). The innovation of using this material in breast reconstruction has enabled the plastic surgeon to place more fluid immediately in the expander which lessens the number of post-operative visits for fills.
The pain/discomfort during the filling process is also markedly reduced because the muscle is not streched nearly to the degree as it is without Alloderm.
Insurance companies do typically cover the use of these materials in CT.
What is Alloderm?
Alloderm is a dermal matrix from cadaver skin. The skin is processed, removing all living cells, antibodies, and identifiers from the donor. What this process leaves is a lattice of collagen. Essentially, Alloderm is a framework of protein. There is nothing "living" in Alloderm. Imagine removing everything from a house except the 2x4 framework. If your skin is the house, then the 2x4 framework is the Alloderm.
After it is placed in the body, new blood vessels will grow into this collagen matrix and it will become "incorporated," meaning that the Alloderm is eventually replaced by your body with your own tissue. It's preferred use in breast reconstruction is due to many factors:
1. It is important to isolate the expander or implant from the overlying mastectomy skin flaps. The upper two thirds of the expander is covered by the pectoralis muscle and Alloderm creates a "sling" to cover the lower third of the expander/implant. This isolates the device from the overlying skin.
2. Alloderm allows for very precise definition of the inframammary fold. This is the skin crease where the bottom portion of the breast meets the chest wall. When reconstructing a breast, this is one of the most important landmarks.
3. Alloderm allows for expansion. When creating a breast, you want a tear-drop shape. Alloderm allows for greater expansion than the pectoralis muscle. This affords a tear-drop shape when used with an expander.
I hope this description helps you. Any new advance in surgery takes awhile to catch on. Alloderm is no exception. Also, please note that Alloderm is not the only dermal matrix out there, although it does have the longest track record.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.