What happens if the Alloderm isn't incorporated on the lower breast skin flap? If it is free floating in the breast pocket?

If the AlloDerm graft does not incorporate to the tissues, it will be free floating. The AlloDerm graft will not be reabsorbed and will eventually "ball up" and turn into thickened scar tissue. If the graft does not take and become vascularized, there is also a higher risk of infection. Good luck.

Though rare, non-incorporation happens. The alloderm does not develop cellular integration and new blood vessels within the tissue to which it was transferred. In this case, the graft can be sterile and in the same capsule as the breast implant or tissue expander. Sometimes this can be a problem, but most of the time doctors and patients are unaware.In most cases, there is only a portion of the alloderm that is not incorporated and when I encounter this in breast reconstruction patients, for example when the expanders are changed for implants, I will remove the portion that is not integrated.

I have used Alloderm for a variety of reconstructions and it does incorporate.  In instances of inadequate fluid drainage or infection it will take longer to incorporate of be unable to do so until the wound has been treated appropriately.

Yes the part that is not attached can be free-floating. However it is pretty rare to have the entire piece not incorporate. Therefore, even with only a few spots incorporate they will hold the entire piece of Alloderm in place. If it was free floating you would be able to feel that as a mobile lump and I doubt that will ever happen.Good luck!

Yes, if  for some reason the acellular dermal matrix doesn't incorporate as planned, it can be "free-floating". Unfortunately, if this does occur, it can be a potential source of infection.  On the other hand, it may not cause a problem. Best wishes.

This can be a real issue particularly if there is seroma (yellow fluid collection) in the pocket between alloderm and the skin. This is generally preventable by using a suction drain for an adequate period of time till the fluid stops draining. The period for this to happen is not well defined and varies with patients.It is critical for the alloderm to stick up as it will not do the job of supporting the implant based reconstruction in the lower pole of the breast. Persistent fluid is an infection risk with free floating alloderm.There are different approaches to this problem and if fluid is persistent than ultrasound can be done with removal of (aspiration) of excess fluid. This may work in promoting sticking of the alloderm.If the fluid is minimal then it may be resorbed by the body and the area should heal up.Another approach is to expand the device and see if it helps in reducing space between the alloderm and the skin.There is no really easy option and every effort must be made to make it work. Antibiotics may also be necessary to prevent any infection after cultures of the fluid within.

Non-incorporated Alloderm occurs when the biologic is not in close contact with surrounding healthy tissues.  I have found portions of ADM free floating in the pocket as your describe but that is the the best case scenario.  More often than not, non-incorporated ADM is an infection risk.

Hi Cagle,Alloderm is a sheet of de-cellular skin used to create a soft tissue layer. This occurs by your own tissue growing into it and replacing it - generally over a 6 to 9 month timeframe. When this doesn't occur, I usually see problems. Whatever the cause for non-incorporation (infection, seroma, radiation, recurrent shear forces...) generally affects the results and portends a possible breast reconstruction complication.  It's not always the alloderm per se but the cause that concerns me. Hang in there, and please follow up with your surgeon. 

When Alloderm is used properly, it is securely sutured to the tissue in the lower half of the breast. It is designed to adhere to the tissue, so that it will stick to it, and is incorporated to the soft tissue coverage over the breast implant. However, if it is not secured well or seroma (fluid collection) develops between the Alloderm and tissue, Alloderm will not be incorporated in the tissue, thus it will be floating within the implant pocket. If this happens, I do not believe it is harmful, but it also is not doing its intended effect.