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Alloderm for Scar Tissue

planning to use alloderm for scar tissue here is question, if I use 375size implant what could be an alloderm size? how long it could be? is it matter by size?

Doctor Answers (5)

AlloDerm and Scar Tissue

+1

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. 


Houston Plastic Surgeon
4.5 out of 5 stars 124 reviews

Alloderm for scar tisue

+1

Assuming you are having a revision breast surgery for capsular contracture (scar tissue) , alloderm is one option being used more recently with some promise to minimize recurrence of the contracture.  It certainly is not a guarantee,  and there is some debate about whether a small strip is adequate or whether a larger piece is indicated.  The material can be quite costly and therefore a smaller piece is more affordable but may not be sufficient.

Discuss your options with your plastic surgeon.  

David J. Levens, MD
Coral Springs Plastic Surgeon
5.0 out of 5 stars 19 reviews

Choosing Alloderm for Breast Scarring Correction

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Regarding: "Alloderm for Scar Tissue
planning to use alloderm for scar tissue here is question, if I use 375size implant what could be an alloderm size? how long it could be? is it matter by size
?"

Unless you are planning a DIY procedure (doubtful) this is a decision which should be left to your surgeon. The Alloderm sheets come in various lengths and thicknesses. The longest / thickest cost the most. The surgeon picks a sheet based on the planned use for the biological. As such, if he needs to add thickness to cover implant rippling, the thickest sheet would be called for - if the length of the defect from the inner edge of the pectoralis muscle all the way to the side is significant, a long sheet would be required.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 63 reviews

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Alloderm size needed

+1

Based on the information provided, the size of AlloDerm needed cannot be determined. Often, the approximate size can be considered, say 10 x 6 cm, for a particular procedure. However, the final decision may be made based on the findings at the time of surgery.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
5.0 out of 5 stars 20 reviews

Alloderm for capsular contracture

+1

I presume you are referring to capsular contracture, a thickening of the scar capsule that forms around breast implants. There is no specific formula for determining the graft size based only on the implant size, each case is different. Alloderm appears to be helpful in treating this condition but it doesn't have to be a big enough piece to cover the whole implant.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 28 reviews

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.