AlloDerm Vs Strattice in Terms of Rejection Rate?

Both products consist of a sheet of collagen matrix from skin with all cells removed. They act as a framework to support the ingrowth of your own tissue over time, and so they are proving very useful in breast  implant surgery, both in reconstruction  and revisions of augmentation. Alloderm is from donated human skin, and it has been in use for more than 10 years with an excellent safety record. It is used primarily for breast reconstruction to support implants. Strattice is a newer product that is porcine derived, and processed so as to be very biocompatible. In other words, even though it is non-human sourced, it behaves the same way as Alloderm in the body. It is used for revisions of augmentation for certain problems, and also for abdominal hernias because it is quite strong. More info on Strattice at renewingyou.com.

Depends on the application.  Like Dr Baxter, I have used these tissues and other scaffolds for over 10 years and I believe each surgeon develops his or her own algorithm on when they recommend each product.  I use Alloderm in Insurance based cases because many insurance companies still reimburse for Alloderm and would recommend it when you are looking for the tissues to stretch and expand like in patients having breast reconstruction...over very poor areas of perfusion of bad blood flow...radiated tissue---heavy scarring---thin tissues etc.If looking for support or particularly for capsular contracture repair particularly in cosmetic patients I prefer Strattice.  Strattice is also less expensive.Some patients have ethical or religious objections to products that are porcine/pig or human based donor tissue as well which we discuss with every patient.The bottom line however is these tissues are treated to remove all cells and impurities that our bodies would react to and are very safe and effective.  Plus many time patients will require additional tissues like these ADM's because their bodies cannot effectively heal without bringing in some additional tissues.We all know the definition of insanity...doing the same thing over and over hoping for a different outcome.  In some patients we have to do something different and add tissue to break the cycle of revision.All my Best!Dr B

Avoid Stratice!  Your own body has a much better structure: Fascia intelligent use of the subfascial plane is the answer

The problems that lead to suggested use of Stratice and dermal fillers are way too common.  The reality of breast augmentation is that most women have similar results and are simply not aware that there is a better option.  The most commonly used technique is the  "dual-plane" subpectoral placement.  this sets up the implants for lateral and inferior malposition.  The top of the breast has muscular coverage and because of the pectoralis major's origination next to the sternum, the implants are pushed away from midline creating the valley between them that you dislike ( I call this the Miami Valley based on the common augmented look of breast augmentations in Miami).  Because the inferior portion of the breast is subglandular,  there is no support and the implant tend to migrate toward the armpits then down.

For these reasons I do not perform submuscular or dual-plane breast augmentations.  I use a technique that I call "Cold-Subfascial Breast Augmentation" that overcomes the shortcomings of dual plane.  By leaving the muscle alone and precisely lifting the strong pectoralis fascia,  I am able to custom design what is essentially a living natural brassiere to support the implant within the breast.  Using this technique I am able to create beautiful natural appearing breasts that complement the individual patient's body.

I commonly revise patients in your position by converting them to the cold-subfascial plane.  In my experience this is the only way to repair the breast and create a long-lived beautiful result.  Artificial materials such as stratice are just asking for trouble in my opinion.  I hope this helps!

All the best,

Rian A. Maercks M.D.

I personally consider them to be the same in terms of incorporation, which is to say "rejection rates" but I would not make a decision to use either one based on that factor, but rather on what you are trying to achieve with the product. 
If you are considering a cosmetic operation to repair a problem with an augmentation (symmastia, rippling, bottoming out, double bubble), or with a lift and an implant (recurrent ptosis, implant malposition), then I personally use Strattice as the properties of the material are better because you need a firm supportive material to correct most of these problems. However, in breast reconstruction I prefer to use Alloderm because it is a softer, more pliable product and can allow the expander and then implant to sit in a more natural position or provide coverage of an implant in reconstructive cases that go directly to implant.

“Rejection” of Alloderm or Strattice is generally not a problem as the immunologic components of the product are removed during processing. The more common problem is exposure of the product or infection. There have been reports of slightly more infections when Alloderm was used for breast reconstruction compared to when it was not used but other studies did not find a difference. One study found a significantly higher rate of needing to remove the expander due to infection or exposure when Alloderm was used. Since Strattice is newer, there are fewer studies available to compare to Alloderm. I am unaware of a study that compares Alloderm and Strattice head-to-head. If you are concerned about this, it would be reasonable to discuss with your surgeon before your procedure.

I have used both products for breast reconstruction with tissue expanders/implants after mastectomy.  Alloderm is human derived acellular dermal graft and Strattice is a porcine derived dermal graft.  Both products are made by LifeCell.  I do not feel the word "rejection" applies to these products.  These products are "acellular" therefore your body should not reject them.  The term to use is "incorporation."  These grafts have no intrinsic blood supply, therefore your body has to vascularize the tissue.  If it gets vascularized, it gets incorporated.  In my experience, the incorporation rates between the two are the same.  Alloderm is more pliable then Strattice.  I have had more drainage from using Strattice vs Alloderm therefore I have had to keep the drains in longer using Strattice vs Alloderm.  This is the main difference I feel.

Alloderm and Strattice are products of LifeCell corporation and are acellular cadaveric (human or porcine) dermal grafts. I have used Alloderm since 1995, first in burn reconstruction, then head and neck reconstruction, during my residency. I used it briefly as a lip implant, however its most popular use is in breast cancer reconstruction where it is employed as an "inferolateral" sling to keep the breast implant or tissue expander in position as well as to "buttress" or thicken the lower part of the mastectomy flap.

Anecdotally, these breast implant patients have been well served by lower than average rates of scar accumulation around these devices. These acellular dermal grafts fuse with the native tissue, as blood vessels grow into it. The rates of "rejection" are extremely rare, however it is very possible to develop a "seroma", or a collection of fluid, which interferes with the graft's adherence. It is typical to use a closed suction drain as well as activity restriction and compression garments, to prevent the protein rich fluid from becoming infected. It is widely held that this "incorporation" phase generally takes 2 weeks. After this time, the chance of "rejection" is extremely low.

The main clinical difference between the two is the distensibility of the grafts. Strattice feels stiffer and so is better matched with abdominal hernia repair and possibly with stabilization of large volume breast implants. Hope this helps.