How is Alloderm Used During Breast Reconstruction?

The use of the acellular dermal matrix (such as AlloMax, AlloDerm, FlexHD, etc.) has grown in its applications and use in plastic & reconstructive procedures, and continues to expand. 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 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. Packaged 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.

Additional benefits seen with the acellular dermal matrix are numerous. There has been a significantly decreased incidence of capsular contracture around the implant at the area of the tissue matrix. Reasons are unknown as of yet, but contracture has been a huge problem in cases of implants used for reconstruction and augmentation. Also, there are tissue regeneration properties of the matrix in which rather than inciting a scarring response, the dermal matrix begins a regenerative process in which it acts as a biologic scaffold and unbelievably, vessels incorporate into matrix and the surrounding cells differentiate into surrounding tissue that it is incorporated into (an amazing concept).

Overall, the use of the acellular dermal matrix in breast reconstruction has been revolutionary. Its applications for tissue expander reconstruction, possibility to use in immediate implant reconstruction (going directly to implants rather than the use of a tissue expander first), revisionary breast surgery, capsular contracture complications, and nipple reconstruction have been great.

I use Alloderm for two reasons. First, it can significantly reduce the risk of capsular contracture after breast reconstruction with implants. Secondly, it provides additional support on the lower and lateral aspects of the breast mound to allow for more even tissue expansion during the first stage of the reconstruction.

Alloderm is an acellular dermal matrix that is often used to reconstruct the lower pole of the breast.  This technique allows the lower part of the breast to appear more curved and natural and prior reconstructive techniques.  Studies have also demonstrated that Alloderm may diminish the risk of capsular contracture, or tighening of scar tissue around an implant, when used in implant-based breast reconstruction.

Alloderm or equivalent products are used for two things in general:1.  They provide coverage of the implant in the lower pole where the muscle (pectorals major) does not extend to.2.  It is used to recreate the support at the bottom of the breast to help hold the implant from shifting out of position.  Often when a general surgeon does a thorough mastectomy the support structures can be disrupted.Rodger Shortt, MDOakville Plastic Surgeon

Alloderm, or other similar products, are frequently used in breast reconstruction with expanders and implants. The expander or implant is placed below the muscle (pectoralis major). Themuscle only covers the top half of the implant. In the past, other muscles were also mobilized to cover the inferior portion of the implant or expander. In the present time, many surgeons use the Alloderm or similar acellular dermal matrix to cover the lower half of the implant. From El Paso, Las Cruces, Mexico.

Alloderm is a tissue substitute and can be used to add buffer tissue for patients with thin skin overlying a breast implant after breast reconstruction. 

Alloderm is a product that consists of freeze-dried, irradiated, cadaveric dermis (skin). Alloderm is very useful for implant-based breast reconstruction for several reasons:

1) It covers/protects the lower pole of the implant.

2) It helps the surgeon to more easily re-establish the infra-mammary fold.

3) Some studies have shown that it reduces the incidence of capular contracture.

Alloderm, or any of the other biological products, has taken the place of the lower muscles that used to be integral to breast reconstruction with a tissue expander or implant. When undergoing breast reconstruction with a tissue expander, the expander is covered by your pectoralis major muscle. However, this only covers the top portion of the expander.
Ten years ago, the standard was to lift up some of your abdominal muscle and side muscles to cover the expander completely. Howeever, this has three problems. It was very painful after surgery, disrupted more of your natural anatomy, and did not allow the expander to really create a nice inframammary fold.
The Alloderm has taken the place of these muscles. It allows the expander to really sit where it is placed and create a nice fold, while not disrupting any other anatomy, and there is much less pain. The Alloderm gets incorporated into your own tissue by about 6 weeks, and becomes part of your natural tissue. The infection rate is extremely low, and there is no rejection of the material itself.

Thank you for your excellent question. Alloderm and other acellular collagen products have revolutionized our results in implant based breast reconstruction. Historically, when implants were first used in breast reconstruction, they were put under the skin in the breast pocket. However, this resulted in complications mainly related to capsular contracture, or thickening of the tissue that the body naturally forms to cover the implant. To prevent this problem, surgeons then started to place the implants under the chest muscles, which decreased capsular contracture but resulted in more painful and less natural results. Once collagen matrix were popularized, the lower part of the implant was then covered by the collagen, and only the top of the implant was then covered by the pectoralis muscle. This has now evolved to full coverage of the implant by collagen and not the muscle which has the advantage of preventing skin rippling when the muscle contracts as well as more natural results. 

Alloderm, which is a processed piece of human skin (refer to the link referenced below), is used in some cases of breast reconstruction. After mastectomy, the remaining skin may be really thin and Alloderm can be used to reinforce this. It can also be used to add support to the expander and/or implant used in reconstruction. In the process, it adds definition to the lower pole of a reconstructed breast.