Can Alloderm Be Used After Expanders Are Placed for Breast Reconstruction?
- Asked by ER girl in NM
- 3 years ago
I am having breast reconstruction surgery in April. I presently have expanders bilat. The pain I am experiencing EVERY morning is located 180 degree on the upper part of the L. breast. It radiates to the axilla and portion of the arm. The L. breast is where I had the cancer. The pain is subsided after 30 min. after I get out of bed.
I believe the muscles are not supporting the expander; therefore, causing the pain. I will be talking to my Dr. about alloderm. Can the alloderm be added when the implants are placed or is it too late?
Pain from tissue expander following breast reconstruction
The alloderm can be added at any time. It may provide some relief if performed in combination with a capsulotomy. However, I am aware that you previously asked this question. It is possible that once expansion is completed you will experience relief or that a smaller implant will provide less tension on the muscle. THere are other possible causes of the pain such as intercostal brachial cutaneous neuralgia which will not be relieved with either course of action.
Alloderm can be used in second stage breast reconstruction surgery
Alloderm can be used in the first or second stage of breast reconstruction surgery. If used during the first stage it allowes full coverage of the implant and a quicker expansion period. It can be placed at the time of exchange of the tissue expanders for permanant inplants. During this operation is it used to cover thin areas of the skin to avoid rippling. It has also been shown in some studies to help stop capsular contraction from forming.
The best thing is to discuss you wishes and concerns with your doctor.
Alloderm for pain?
It is unclear exactly why you have this pain but it could be from stretch of the nerves leading to irritation. An exam is certainly helpful to figure out what is going on.
Recent Breast Reconstruction Reviews
Breast Reconstruction Photos
AlloDerm in Breast Reconstruction
AlloDerm is utilized to facilitate one-stage and two-stage implant reconstruction after mastectomy. AlloDerm is essentially a collagen matrix (or a sheet of collagen) that is derived from a human source. It is used to create a retaining envelope for your implant. Compared to traditional total muscle coverage techniques, many believe AlloDerm use decreases postoperative discomfort and significantly improves the cosmetic results of implant-based reconstruction. Although AlloDerm is most commonly utilize at the time of tissue expander placement, it can be used in secondary procedures. Specifically, it has an excellent role in pocket control, correction of a bottomed out implant, and other implant deformities. In addition, there is emerging evidence to suggest AlloDerm may have a role in the treatment of capsular contracture (scar tissue around your implant).
Web reference: http://www.breastreconstructionhouston.com
Alloderm for 2nd stage implant reconstruction
generally, alloderm or a dermal matrix is used during the initial tissue expander placement to help recreate the inframammary fold and protect the lower pole of the expander.
It seems that your pain is due to edema or irritation of the sensory nerve to your inner arm. This can be injured during mastectomy and node sampling.
I would recommend physical therapy to assist with your upper breast pain. I do not believe alloderm is indicated for your concern.
I wish you a safe recovery.
Web reference: http://www.drpaulgill.com
Alloderm for Breast Reconstruction
Let me start by saying I don't use Alloderm. Why? It's not sterile!!! I understand it has been on the market the longest but that doesn't change the fact that most people that have used it know about "red breast." This is the body's reaction to one of the 3 antibiotics that are used in the cleaning process of the tissue. The Alloderm ends up having to be removed. There are plenty of sterile acellular dermal matrix products without the need for Alloderm.
Okay enough bashing of Alloderm. Yes an acellular dermal matrix can be used at any time. Most surgeons now days put it in the matrix at the time of the expander. This allows the inframammary fold to be well defined as well as the lateral boarder of the breast. It also put another layer between the expander and the outside.
Pain of the upper breast that is highest in the morning that resolves after 30 minutes is most likely due to edema. When we lay supine or prone during sleep our body fluids equilibrating or even out over our entire body. So during the day most fluid falls to our legs and it returns to the rest of the body during sleep.
In your situation I don't think the pain has to due to with support of the expander as it does with edema.
Alloderm and Breast Reconstruction
The Alloderm hammock can be placed either at the time of the
- Expander removal and placement of the implants.
The AlloDerm has several important functions. It stabilizes the position of the implant (and under the breast fold) by resisting downward sagging of the implant and it offers more cover and soft tissue on the bottom and sides of the implants (between them and the skin) for a more natural result AND a buffer should there be a small area of skin breakdown.
The AlloDerm may or may not help with the pain you describe and you should discuss it with your surgeon.
The use of Alloderm in breast reconstruction
Alloderm can be used during stage 1 (immediate) breast reconstruction, when tissue expanders or implants are placed following a mastectomy. It can also be placed during stage 2 breast reconstruction (when tissue expanders are removed and replaced with implants).
Alloderm serves several functions including:
1) allowing the inframammary fold (fold under the breast) to be reestablished and
2) allow the breast pocket, under the chest muscle, to be larger thereby allowing more room for an implant as well as the ability to place a larger implant.
In terms of the breast discomfort you are experiencing, the alloderm may help by increasing the size of the breast pocket thereby creating decreased tightness around the implant that will be placed. Your pain may also be addressed by placing an implant that is smaller than the volume of your tissue expander. Lastly, you may benefit from a capsulotomy/ capsulectomy (internal breaking up/ removal of scar tissue that forms around an expander) to address your pain.
Alloderm in Breast Reconstruction
Alloderm can be used at any time, but I am concerned that you think it will make a difference in your comfort.
I do not believe placing Alloderm will make ANY difference in your discomfort...
Without knowing more, it is impossible to know what IS causing your pain, but in most cases like yours, pain is caused by tightening of the implant capsule (contraction) your body has formed around the expander. Because the expender is so rigid, and because this scar tissue often connects with the scar in your axillae (from the lymph node dissection), tightening of the scar tissue can cause significant pain and often does radiate into the armpit.
There is no reason that Alloderm, in and of itself, will improve this.
I DO think that careful release of your capsules at the time of surgery and appropriate capsular management in the postoperative period will improve this however.
If you need Alloderm to improve the aesthetic outcome of your breast reconstruction, that's one thing- if what you are looking for is comfort, it probably won't help as much as what I describe above.
Web reference: http://www.DrArmandoSoto.com
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.