Foreign body reaction with strattice. Alloderm an option?

Clearly, your tissue is very reactive based on your history. I would encourage you to wait on further reconstruction with foreign tissue until all the inflammation has settled and there is no residual granuloma or inflammatory tissue. Best, Dr. Karamanoukian Los Angeles

Strattice and Alloderm both go through a process of removing
the cell to create a dermal scaffold. There is certainly a chance that you
could have a reaction to the alloderm. I have not seen a significant reaction
to alloderm when used in breast reconstruction. There is a described red breast
where there is a persistent redness that look like a low grade infection. You
don't describe what reaction that you had to the strattice. There are other
products such as Seri (a silk mesh) that have recently come on the market to be
used to support an implant. This is a newer products so there is less reported
on the possible side-effects. Without examining you it is difficult to discuss
other options. However, the latissimus flap could be used, with or without a skin
paddle, to provide support and volume over an implant. The other options
include free flap transfer such as from the inner thigh (TUG flap) or the
buttock (SGAP or IGAP flap). Once transferred an implant can be placed behind
the flap for volume if needed. You should consult someone in your area whom has
experience with secondary reconstruction via both local and microsurgical
options.

Sorry to hear of your predicament, however I agree that you may experience similar untoward reactions with Alloderm.  Can you elaborate on the exact nature of the unfavorable reaction? Seroma? Palpability? Firmness? Asymmetry? You are correct that thin patients have limited donor sites for fat transfers so implant based reconstructions are generally preferable.  Assuming you had a skin sparing technique, you might consider delayed reconstruction(i.e. 4 years after the fact), using Seri scaffolding and a tissue expander, as step 1. Seri scaffolding is Allergan's tissue engineered silk, which both "thickens" and supports breast procedures.  Ask your PS consultants, how much experience they have had with this emerging technology.