I Have a Hernia Due to DIEP Surgery. Is Alloderm Safe for Hernia Repair?

Thank you for the question!  I'm sorry to hear of this unfortunate event following your DIEP flap.  Acellular dermal matrices (e.g., AlloMax, AlloDerm, FlexHD, etc.) are collagen sheets derived from human cadaveric donors, which have been treated to remove antigenic cells and such.  While they have revolutionized breast reconstruction in particular, they have been used to treated hernias and bulges for the abdominal wall.  

It is quite uncommon to develop a true hernia following a DIEP flap, since the muscle should be kept intact and abdominal wall integrity changed very little if any.  Bulges are more common, but much less than a muscle-sparing TRAM or the conventional TRAM flap, where the a portion or the entire muscle is harvested for the reconstruction of a breast.  Regardless, these dermal matrices act as a scaffolding for tissue ingrowth and may be used for abdominal wall repair.  The downside of these are the predictable stretch that occurs once placed.  Although desirable for breast reconstruction in order to obtain better shape, it is not as ideal for the abdominal wall repair, as you ideally do not want any stretching following repair, but certainly could be used.  

Your surgeon may consider a porcine dermal matrix which has much less stretch than the human type.   If you are experiencing some bulging of the abdomen along with some discomfort, repair should be entertained and repair via tightening of the fascia alone or with the use of either human or porcine dermal matrix, or even a mesh, could be done.  I hope that this helps!  Best of luck with this!

Both products are acellular dermis, meaning that they come from skin with the cells removed leaving the collagen matrix. This acts as a template for your own tissue to grow in. Alloderm works very well in the breast to support implants, but Strattice is stronger and less flexible so a good choice for hernias.

Alloderm has historically been used for hernia repair, but bulging following this repair is not infrequent.  Thus, stronger materials are now more commonly chosen for hernia repair including various synthetic meshes.  Alloderm is cadaveric dermis that is depleted of human cells and antigens, so it is not rejected by an immune response from the recipient.  it serves as a scaffold that is incorporated with recipient cells, but it has limited strength.  The abdominal wall is subject to continuous torsion and strain, and alloderm is inconsistent in its ability to withstand this force.  Thus synthetic meshes are often a better choice for hernia repair. 

Hang in there. I hope you are happy with your DIEP reconstruction. Over time, patients with DIEP reconstruction are happier than they were initially, in part probably because of bumps in the road such as your hernia. 
Alloderm was used for hernia repairs routinely about 15 years ago but the fact that is tends to stretch makes it not as good as other products, both tissue-derived and mesh, which can be effectively used to repair hernias. I recommend you talk with your surgeon and ask what material they plan to use for your hernia repair and why it is their preferred choice. 

Hello, 

I'm sorry to hear you developed a hernia following your DIEP flap. Alloderm is an option for repair but typically we see this stretch too much and you will have weakness in the repair. Instead, Strattice is a material made also by LifeCell and is commonly used to repair abdominal wall laxity or hernias. The material is made from porcine dermis and is thus much stronger and less likely to stretch but is still a biologic that is unlikely to get infected. Good luck! 

It is extremely rare to have a bulge or hernia after a DIEP flap breast reconstruction, on the order of 0.6%.     It is much more likely to occur after TRAM Flap Breast Reconstruction, where the muscle is removed, on the oder of 11%.

With the presence of a bulge or hernia, I would recommend an underlay mesh repair with a product such as Strattice or a synthetic mesh.   Although the  risk of infection is slightly higher, a more durable mesh will allow for a longer lasting repair with less chance of recurrence.

Alloderm is a safe product for hernia repair but is not ideal.  There are several materials that can be used to perform repair of bulges which are typically what develops after surgery and a weakening in the fascia where the incision was made to follow the perforator and ultimately the blood vessels that would be hooked up to your chest later.  I have seen these most common in bilateral DIEP flap cases but they can occur in unilateral cases.  Each surgeon will manage differently but simply praline mesh repair is appropriate in these cases.

Do you truly have a hernia or is it a bulge in your tummy area?   I concur with my colleagues.  AlloDerm does tend to stretch and its likely not the best option to correct a bulge or hernia.   Rather a more firm product like Strattice (porcine product) would be more helpful to improve your tummy area

Alloderm is safe in repairing abdominal hernias, however, it is usually not the material of choice for most plastic surgeons today.  This is because the properties of Alloderm that make it great for the breast (stretching and incorporation) make it a lesser choice for fixing hernias that really need to be tight and not stretch.  There are many other products on the market now that would be better for your repair.
 

Alloderm is made for cadaver human skin. One important characterstic is that Alloderm stretches significantly with time. If Alloderm must be used we tend to use thicker pieces, or we just used a synthetic mesh.