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Is Alloderm or Strattice Needed for Implant Reconstruction?

I recently had a prophylactic mastectomy and developed a rather odd complication of persistant drainage with alloderm. My skin would open and drain. I did not have an infection and was tested multiple times. I even visted a wound clinic and had numerous lab tests and no infection was found. I did not stop draining until all alloderm was removed. I am a thin woman with not enough tissue to do a transfer for reconstruction my breasts. Can I still get implants without alloderm or strattice?

Doctor Answers (9)

Fluid and redness after Alloderm

+2

I use Alloderm and Strattice regularly for complex reconstructions of the breast and body. Alloderm, especially in the breast, does cause more fluid to build up. This requires that drains be left after surgery for longer than if alloderm was not used. It is not uncommon to need the drains for 2-3 weeks.  Another "unusual complication" is what we call "red breast syndrome." It is a persistent redness that occurs on the breast overlying the alloderm. This is probably an inflammatory reaction as the alloderm incorporates. It looks like an infection, but there is no bacteria. It resolves on its own but can take several weeks.

 

Regardless of what really happened to you, it is possible to reconstruct a breast without alloderm. Remember, alloderm has only been widely used for the past 5-7 years.....but we have been doing breast reconstruction much much longer.  Alloderm may help in certain situtations and may help prevent some common problems, but it is not necessary if you have had a bad reaction.


New York Plastic Surgeon
5.0 out of 5 stars 188 reviews

Is an acellular dermal matrix necessary for implant reconstruction?

+1

The use of the acellular dermal matrix (FlexHD, AlloMax, AlloDerm, etc.) has grown in its applications and use in plastic & reconstructive procedures, and growing. It has truly been a remarkable addition for breast reconstruction.  It is not a necessary tool in implant-based breast reconstruction, but certainly has its advantages.

The acellular dermal matrix is a tissue that is specially-prepared, which comes from cadaveric skin. It is placed on the inside, not on your skin.  It has been processed in such a way that the basement membrane and cellular matrix remain intact, while removing all other cellular components that may lead to both rejection and infection. Packages as a sterile tissue product, due to its preparation, the chance of acquiring viruses and such is nearly absent.

Its applications for breast reconstruction alone include its use in tissue expander/implant reconstruction, to act as a "hammock" at the inferior portion of the breast for which the implant lies within. This creates a natural "sling" which mimics the ptosis (sag) of the breast, while supporting it in place. By suturing this matrix to its exact position of the breast margins, the plastic surgeon is able to precisely recreate an excellent contour for your breast, especially at the inferior, medial, and lateral positions. This also minimizes migration of the implant, as sometimes seen with "bottoming out" inferiorly or its displacement into the axilla (armpit). In addition to its increased aesthetic results, the acellular dermal matrix provides additional coverage over your implant. This is especially useful in those instances of dehiscence (your incision opening up), thus protecting the implant from exposure, and threatening its necessity for removal. Furthermore, in cases where the overlying mastectomy flaps are thin or damaged, leading to partial flap necrosis, the tissue matrix again provides a coverage over your implant, which can heal over time or a graft placed over the are or simply closed. Lastly, the additional coverage lessens implant visibility and palpability and is a great adjunct for revisionary breast surgery. The use of this matrix, along with the advantages listed above, has reduced the time of the reconstructive portion of the procedure as well. There is less pectoralis muscle retraction and eliminates the need to raise any other surrounding muscles in order to achieve complete implant coverage.

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Use of alloderm or strattice in breast reconstruction

+1

Persistent drainage after reconstruction with Acellular dermal matrices such as alloderm is one of the most common reported problems and should be expected. Occasionally it can be associated with redness of the overlying skin and appear consistent with an infection or allergic reaction. Overall, I do believe it has improved the results. One other alternative used with controversially equivalent results to alloderm is the use of vicryl mesh. Discuss these with your surgeon.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

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Issues associated with Breast Reconstruction with Alloderm or Strattice ADM's

+1
Acellular Dermal Matrices such as Alloderm (human) or Strattice (pig) dkin dermis have greatly improved both Cosmetic Breast Surgery and Reconstructive Breast surgery. These biological sheets are used to support the implants (preventing sagging), increase skin thickness over the implants (decreasing implant palpability) and interfere with scar tissue formation (in operationsfor removal of capsular contracture). The problem with these biological sheets is that while the body slowly incorporates them,making them part of your tissues, they are associated with prolonged drainage which is frustrating to the patient and the surgeon. Before giving up and attempting implant reconstruction WITHOUT the use of ADM's the patient must be educated on the greater risks of implant sagging and capsular contracture and certainty of fold visibility and palpability. Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 61 reviews

Reconstruction

+1

Yes.  That is the answer.  Submuscular pockets were used extensively prior to the advent of dermal matrices.  And they worked.

David A. Lickstein, MD
Miami Plastic Surgeon
5.0 out of 5 stars 3 reviews

Implant reconstruction without Alloderm

+1

You can absolutely get reconstruction without Alloderm although Alloderm and Strattice is in vogue because it gives a surgeon more control over the position of the implant. However we have done implant reconstruction for decades without Alloderm. Personally I feel this is overused and not without risks such as in your case.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 8 reviews

Alloderm is very helpful for breast reconstruction

+1

The reason for the alloderm in breast reconstruction is to make an internal bra that supports and covers the implant, but it can be associated with more drainage. Strattice is a stiffer material more suited to revisions rather than primary reconstruction. I would still be in favor of using the alloderm with the next reconstruction.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 25 reviews

Alloderm and drainage

+1

I prefer to use alloderm during breast reconstruction.  If you had it all removed and have healed up presumably from an infection?  You may want to wait 4-6 months to consider restarting again. In that case if you were my patient, I would consider using alloderm again.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Breast reconstruction without Alloderm or Strattice

+1
Call me old fashioned, but I believe these substances are overused. We got excellent reeconstruction for years without them, and can still do so most of the time.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 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.