Alloderm for Breast Reconstruction?

Question

This is being tauted widely as the best breast reconstruction procedure out there for women to get through this terrifying and tramatic experience. Unfortunately, many doctors do NOT know how to do this procedure yet, hence it is not widely available leaving patients to not be able to have it as an option insurance-wise. I have never heard anyone say anything about Alloderm not being sterile and not wanting to put it near an implant. Can you please elaborate?

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  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.  Hope that this helps!  Best wishes!

Arturo Guiloff, MD · Answer

AlloDerm product is human donor skin that has been treated to not cause rejection, leaving only a dermal collagen matrix. The dermal collagen matrix is incorporated by the hosts own body tissues. It has significantly improved results in breast reconstruction and also in complex aesthetic cases with recurrent intractable capsular contractures.

Farhad Rafizadeh, MD · Answer

Alloderm, is a product made by life cell corporation. It is the first to popularize the product for breast reconstruction. This product is a cadaveric skin that has been treated to not cause rejection. The dermal collagen matrix is repopulated by the host's cells and integrated in the body. Alloderm is not truly sterile but It has been treated with antibiotics to be aseptic. There are other products on the market now. Some of them are sterile. These products have revolutionized the implant breast reconstruction. And have made the surgery much more successful. Any surgeon doing breast reconstruction routinely should offer these products and at least discuss the pros and cons with the patients.

Christopher V. Pelletiere, MD · Answer

Alloderm really is now the standard or care with any sort of immediate breast reconstruction utilizing tissue expanders/implants.  If a surgeon is not familiar with the techniques, then they probably do not do alot of breast reconstructiuons.  Alloderm spares some muscle dissection, really helps secure the expander/implnat, and really helps with the inframammary fold area. 

	The rates of infection are extremely low, and their really should be no rejection of the tissue even though it is human derived.  I have used Alloderm hundreds of time against expanders and implants without problems.  I hope this helps.

Raj S. Ambay, MD · Answer

AlloDerm is essentially cadaver skin minus any living cells. It is used as a scaffold through which a persons living cells can grow into. It has many uses, but, in use his in breast reconstruction. AlloDerm does not help in mastectomy recovery. It does however help in breast reconstruction. In this application, AlloDerm was used to cover the lower portion of an implant that spans from the lower border of the pectoralis muscle to the breast fold. Because AlloDerm is a foreign substance in can always get infected and as such your doctor and you need to pay close attention to the signs and symptoms. AlloDerm has also been used in nipple augmentation as well as augmentation of other body parts. Its efficacy is really not known in these realms because it is not common. Some providers may use AlloDerm for these applications but please note that its most widespread use is particularly in breast reconstruction as well as repair for abdominal wall hernias. Please speak with a board certified plastic surgeon if you have any specific concerns regarding your care.

W. Thomas McClellan, MD, FACS · Answer

Alloderm is an acellular dermal matrix that is used for breast reconstruction. Our bodies use the allograft as a scaffold in which to incorporate (grow into) new tissue. Alloderm has been very well studied in breast cancer reconstruction and is known to have a higher infection rate(~15% higher) and seroma rate (~10% higher) than traditional breast recon. (Seroma = collection of fluid) However the infection and seroma rates can be effectively lowered by good patient selection (non smoker, no diabetes, no obesity), and good surgical technique (good hydration of the allograft prior to placement, strict hemostasis, proper drain placement and time (typically 5-7 days), securing the allograft to the underside of the skin, and proper orientation of the allograft (there's an up and a down side)).
	Even with the higher reported rate of inection and seroma I have not seen this to be a problem. Alloderm has a long history of being safe in the body. It is my choice of allograft for reconstruction as the integration rate is superior to all other allografts. Meaning it becomes part of you very quickly. The other types of allografts use various chemical treatments which delay integration and may lead to infection and non integration.
	I have invented a new tissue expander to help with all allograft reconstructions and reduce the chance of infection and reduce seroma formation.
	I hope this helps.

Robert Whitfield, MD · Answer

You should see a breast reconstruction surgeon who is comfortable discussing all of you options. The material is not difficult to use. it is most commonly used in expander/implant reconstruction or direct implant reconstruction.

Michael H. Rosenberg, MD · Answer

there are times when it is an extremely important part of the reconstruction, and other times when it is not necessary. Basically, alloderm is an acellualr dermal matrix, harvesteded from the underside of human skin and, after the cells are removed, prepared for use in patients. It can be extremely helpful in breast reconstruction with both expanders and implants, making the reconstruction quicker and easier, and often improving the appearance of the reconstructed breast. When used with expanders, it can quicken the time to expansion and help guide the vector of expansion for ptimum results. It can also allow us to perform immediate reconstruction with implants in select patients, thus avoiding an entire operation to remove the expander and replace it with a permanent implant. It also can help us place the implant along the exact inframamamry fold, improving the appearance of the breast.

Tom J. Pousti, MD · Answer

You are correct that not many surgeon's understand the use of the AlloDerm product. It is very important to do your research and chose a surgeon who has worked with this product before. There are many factors related with reconstruction of the breast - please make sure you are seeing an experienced board certified plastic surgeon to assist you.

Samer W. Cabbabe, MD · Answer

The "best" breast reconstruction depends on many variables, including patient breast size, unilateral or bilateral reconstruction, patient body habitus and history of radiation. In terms of tissue expander/implant reconstruction, using alloderm is not necessarily better than not using it. As a plastic surgeon that offers both options, I can tell you that there have been studies in our main journal that have shown no difference in cosmetic outcome for tissue expander/implant reconstruciton with and without alloderm. I prefer to use alloderm in a one - stage reconstruction. If more than one - stage is needed, then the advantage decreases.

Alloderm for Breast Reconstruction?

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