Advantages & Disadvantages to Alloderm Put in During Implant Exchange?

The use of the acellular dermal matrix has grown in its applications and use in plastic & reconstructive procedures, and growing. It has truly been a remarkable addition for breast reconstruction.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.  Best wishes!

In my New York City plastic surgery practice, I have observed that if AlloDerm is used in breast reconstruction, it is usually placed immediately before tissue expanders are inserted.  AlloDerm has more elasticity than Strattice which is advantageous when stretching the skin.  It is available in a sterile manner (which was not always the case) and minimizes the amount of dissection that needs to be performed during surgery.  Over time, AlloDerm and the sutures which secure it dissolve.  No ridge should be apparent along the suture line  once the sutures (stitches) have dissolved.

Alloderm is an acellular dermal matrix that is tranformed into living tissue over time to form a sort of internal bra. This helps to support implants and allow for a better shape to the breast. There is evidence that it also helps to prevent capsular contracture, which is more common in reconstruction than in augmentation. The Alloderm is sewn to the pectoral muscle, so the muscle covers the upper part of the implant and the Alloderm the bottom part. You should not feel much of a ridge but it depends.

Generally, Alloderm is used during the first stage of a two stage breast reconstruction. The use of it in the second stage to make a sling is useful if the lower mastectomy flaps are very thin and there is concern about rippling. The suture line in either use of alloderm will dissolve but depending on the suture it can take time. The major downside of putting alloderm at the second stage would be an increased risk of seroma. This can lead to infection and other problems. Many surgeons recommend the use of drains with the placement of alloderm. I usually don't use drains for the implant exchange but would be more likely to do so if I was going to place alloderm. The question to ask your surgeon is why the think you need an alloderm sling and how if would improve your results. I am sure they have a good indication and should be able to explain the rationale to you in the office. Good luck. 

Most surgeons will use the alloderm during the first stage when the tissue expanders are placed to help add shape to the lower pole of the breast.  It also results in less pain and easy expansion.

A new technique that some surgeons are now trying is to place a small sheet of strattice or alloderm during the tissue expander to implant exchange along the upper pole of the breast to reduce the risk of capsular contracture.  I do not feel the benefits outweigh the risks on this.    I have not seen issue s with ridging of the suture line with alloderm and find it has little effect on the pectoralis muscles.    

I wish you a safe recovery and fantastic result.

Dr. Gill