Can Alloderm Be Used After Expanders Are Placed for Breast Reconstruction?

I am having breast reconstruction surgery in April. I presently have expanders bilat. The pain I am experiencing EVERY morning is located 180 degree on the upper part of the L. breast. It radiates to the axilla and portion of the arm. The L. breast is where I had the cancer. The pain is subsided after 30 min. after I get out of bed.

I believe the muscles are not supporting the expander; therefore, causing the pain. I will be talking to my Dr. about alloderm. Can the alloderm be added when the implants are placed or is it too late?

Doctor Answers 12

Pain from tissue expander following breast reconstruction

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The alloderm can be added at any time. It may provide some relief if performed in combination with a capsulotomy. However, I am aware that you previously asked this question. It is possible that once expansion is completed you will experience relief or that a smaller implant will provide less tension on the muscle. THere are other possible causes of the pain such as intercostal brachial cutaneous neuralgia which will not be relieved with either course of action.

Alloderm can be used in second stage breast reconstruction surgery

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Alloderm can be used in the first or second stage of breast reconstruction surgery. If used during the first stage it allowes full coverage of the implant and a quicker expansion period. It can be placed at the time of exchange of the tissue expanders for permanant inplants. During this operation is it used to cover thin areas of the skin to avoid rippling. It has also been shown in some studies to help stop capsular contraction from forming.

The best thing is to discuss you wishes and concerns with your doctor.

Can an ADM be used after expanders are placed for breast reconstruction?

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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.  

While the ADM can certainly be placed at any time, I am unsure if there would be any advantage for you at this point.  I would suggest going slowly with the expansion process and allowing adequate time between fills to allow enough expansion between fills.  Heat, warm showers, and muscle relaxants are also helpful.  Discuss your issues with your surgeon and follow his/her instructions.  Best wishes!

Alloderm for pain?

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It is unclear exactly why you have this pain but it could be from stretch  of the nerves leading to irritation.  An exam is certainly helpful to figure out what is going on.

AlloDerm in Breast Reconstruction

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AlloDerm is utilized to facilitate one-stage and two-stage implant reconstruction after mastectomy. AlloDerm is essentially a collagen matrix (or a sheet of collagen) that is derived from a human source. It is used to create a retaining envelope for your implant. Compared to traditional total muscle coverage techniques, many believe AlloDerm use decreases postoperative discomfort and significantly improves the cosmetic results of implant-based reconstruction.   Although AlloDerm is most commonly utilize at the time of tissue expander placement, it can be used in secondary procedures.  Specifically, it has an excellent role in pocket control, correction of a bottomed out implant, and other implant deformities.  In addition, there is emerging evidence to suggest AlloDerm may have a role in the treatment of capsular contracture (scar tissue around your implant).  

Alloderm for 2nd stage implant reconstruction

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generally, alloderm or a dermal matrix is used during the initial tissue expander placement to help recreate the inframammary fold and protect the lower pole of the expander.

It seems that your pain is due to edema or irritation of the sensory nerve to your inner arm.   This can be injured during mastectomy and node sampling.  

I would recommend physical therapy to assist with your upper breast pain.  I do not believe alloderm is indicated for your concern.

I wish you a safe recovery.

Paul S. Gill, MD
Houston Plastic Surgeon

Alloderm for Breast Reconstruction

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Let me start by saying I don't use Alloderm. Why? It's not sterile!!! I understand it has been on the market the longest but that doesn't change the fact that most people that have used it know about "red breast." This is the body's reaction to one of the 3 antibiotics that are used in the cleaning process of the tissue. The Alloderm ends up having to be removed. There are plenty of sterile acellular dermal matrix products without the need for Alloderm.

Okay enough bashing of Alloderm. Yes an acellular dermal matrix can be used at any time. Most surgeons now days put it in the matrix at the time of the expander. This allows the inframammary fold to be well defined as well as the lateral boarder of the breast. It also put another layer between the expander and the outside.

Pain of the upper breast that is highest in the morning that resolves after 30 minutes is most likely due to edema. When we lay supine or prone during sleep our body fluids equilibrating or even out over our entire body. So during the day most fluid falls to our legs and it returns to the rest of the body during sleep.

In your situation I don't think the pain has to due to with support of the expander as it does with edema.

Breast reconstruction

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The question is, what is the cause of the pain you are experiencing?

Is it capsular contracture, neuroma pain, or is it the pressure?

Would AlloDerm alleviate the pain?

Consult your plastic surgeon. 

AlloDerm can be used any time in the recostructive process.

Samir Shureih, MD
Baltimore Plastic Surgeon

Alloderm and Breast Reconstruction

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The Alloderm hammock can be placed either at the time of the

- mastectomy (as either AlloDerm and expanders leading to a second stage later OR as a one stage AlloDerm and breast implants (bypassing the use of expanders)

- Expander removal and placement of the implants.

The AlloDerm has several important functions. It stabilizes the position of the implant (and under the breast fold) by resisting downward sagging of the implant and it offers more cover and soft tissue on the bottom and sides of the implants (between them and the skin) for a more natural result AND a buffer should there be a small area of skin breakdown.

The AlloDerm may or may not help with the pain you describe and you should discuss it with your surgeon.

Peter A. Aldea, MD
Memphis Plastic Surgeon

The use of Alloderm in breast reconstruction

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Alloderm can be used during stage 1 (immediate) breast reconstruction, when tissue expanders or implants are placed following a mastectomy. It can also be placed during stage 2 breast reconstruction (when tissue expanders are removed and replaced with implants).

Alloderm serves several functions including:

1) allowing the inframammary fold (fold under the breast) to be reestablished and

2) allow the breast pocket, under the chest muscle, to be larger thereby allowing more room for an implant as well as the ability to place a larger implant.

In terms of the breast discomfort you are experiencing, the alloderm may help by increasing the size of the breast pocket thereby creating decreased tightness around the implant that will be placed. Your pain may also be addressed by placing an implant that is smaller than the volume of your tissue expander. Lastly, you may benefit from a capsulotomy/ capsulectomy (internal breaking up/ removal of scar tissue that forms around an expander) to address your pain.

Good luck.

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.