What's Your Position on AlloDerm? Conservative Patient Has Severe Scarring in Implant

I have severe scaring from breast implant and need to have another procedure to remove scar and re insert implant. Doctor suggest to put in AlloDerm to minimize future scaring. I am very conservative and not really convinced that I want it. It's a foreign object that could have unnecessary complications, how small the chance it might be. It's not like I had a mastectomy. Would you say there's a good arguement for and against the AlloDerm in breast implants? Thank you for your time.

Doctor Answers 7

Alloderm is a natural solution to breast implant capsule scarring

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Alloderm is what is called an "acellular dermal graft" which means that it is made from the dermis (deep layer) of the skin with all of the cells removed. It is basically a collagen matrix that is identical in everyone so the body does not see it as a foreign object. Because of that, it serves as a template for your own tissue to grow into it and become permanent. One of the most useful applications of it is the exact situation you describe; when scar tissue has to be removed, there will be less coverage and support for the implant, which alloderm can provide. Additionally, it has been shown that alloderm helps prevent capsular contracture so it serves a dual purpose. The only argument against it is the cost, but there aren't any other options that do what it does except for a newer product called Strattice (from the same company.)

Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Alloderm breast capsular contracture

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The track record for Alloderm has been really for breast reconstruction after mastectomy.  Patients who undergo a mastectomy and have implant-based breast reconstruction are at higher rates of capsular contracture versus patients who have implants for breast augmentation.  Does Alloderm decrease capsular contracture in breast reconstruction is being actively studied, but there is no conclusive evidence that the use of Alloderm will decrease the rate of high-grade capsular contracture.  Does it improve rippling? Yes.  Does it improve "bottoming-out" of the implant? Yes.  Some early reports are that Alloderm might help with capsular contracture.  Nobody knows that cause of capsular contracture.  There are many theories such as infection, bleeding, radiation, etc.  One main thing that does improve capsular contracture is the position of the breast implant relative to the pectoralis major muscle.  If your implant is above the muscle and you have capsular contracture, then performing a complete capsulectomy (removal of the implant), placing a new implant beneath the muscle may decrease the chance of recurrent capsular contracture.  There are also other products like Alloderm that your surgeon may use.  Again, Alloderm is a human-derived acellular dermal graft.  Lifecell which produces it also makes a porcine-derived aceullar dermal graft called Strattice.  I believe Strattice is used more frequently for cosmetic breast patients vs Alldoerm.  It is slightly less expensive.

Peter Ashjian, MD
Glendale Plastic Surgeon

What's Your Position on AlloDerm? Conservative Patient Has Severe Scarring in Implant

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Without seeing you or your photographs it is difficult to give you advice

The other options you need to explore are 

Fat injections  ( fat derived stem cells)  PRP, Synthetic absorbable mesh, ,Brava  and Adjustable implants 

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Capsular Contracture

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The use of AlloDerm for patients who develop capsular contracture to decrease that possibility is being studied.. not proven at this time.  You need to make sure that you are comfortable with your decision for revisionary surgery.  You must understand that (with or without the Alloderm) you do have the chance of getting the scar tissue again after your revisionary surgery.  Some patients choose to have the revision surgery, some choose to remove their implants completely.  This is an important discussion that you need to have with your surgeon.

Does AlloDerm have any impact in the treatment of capsular contracture?

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Great question.  First, if this is your FIRST bout of scar tissue around your implant, I personally would not jump to AlloDerm.  Rather, I would perform a total capsulectomy (removal of scar tissue) and place a new implant in a new virgin pocket (example, transitioning your new implant from the above the muscle position to under the muscle or dual place).   I reserve the use of AlloDerm in recurrent capsular contracture cases where other more established/traditional techniques have failed. Now, your other question was on AlloDerm and its role with capsular contracture.

There is emerging data showing that AlloDerm may have a role in slowing down or preventing capsular contracture. In fact, I published a clinical paper on this very topic in December 2010 issue of our primary plastic surgery journal: Plastic and Reconstructive Surgery. However, even as an primary author of this study, it is still too premature to guarantee that ADMs prevent capsular contracture. But there is growing evidence support this claim. 

Dr. Basu

Basu Plastic Surgery - Houston, TX


Plastic & Reconstructive Surgery: December 2010 - Volume 126 - Issue 6 - pp 1842-1847 doi: 10.1097/PRS.0b013e3181f44674 Breast: Original Articles Acellular Cadaveric Dermis Decreases the Inflammatory Response in Capsule Formation in Reconstructive Breast Surgery Basu, C. Bob M.D., M.P.H.; Leong, Mimi M.D., M.S.; Hicks, M. John M.D., Ph.D.

AbstractBackground: Acellular cadaveric dermis in implant-based breast reconstruction provides an alternative to total submuscular placement. To date, there has been no detailed in vivo human analysis of the histopathologic sequelae of acellular cadaveric dermis in implant-based breast reconstruction. Based on clinical observations, we hypothesize that acellular cadaveric dermis decreases the inflammatory response and foreign body reaction normally seen around breast implants.

Methods: Twenty patients underwent tissue expander reconstruction using the “dual-plane” acellular cadaveric dermis technique (AlloDerm). During implant exchange, intraoperative biopsy specimens were obtained of (1) biointegrated acellular cadaveric dermis and (2) native subpectoral capsule (internal control). Histopathologic analysis was performed. Masked biopsy specimens were scored semiquantitatively by an experienced histopathologist to reflect observed granulation tissue formation, vessel proliferation, chronic inflammatory changes, capsule fibrosis, fibroblast cellularity, and foreign body giant cell inflammatory reaction. Scores were analyzed statistically using the Wilcoxon signed rank test.

Results: Acellular cadaveric dermis (AlloDerm) had statistically diminished levels for all parameters compared with corresponding native breast capsules (p < 0.001).

Conclusions: This represents the first detailed histopathologic comparative analysis between biointegrated acellular cadaveric dermis and native capsules in implant-based breast reconstruction. These histopathologic findings suggest that certain properties intrinsic to acellular cadaveric dermis may limit capsule formation by diminishing inflammatory changes that initiate capsule formation. Further investigation is needed to determine whether acellular cadaveric dermis reduces the incidence of breast capsular contracture.  

Is alloderm useful to prevent capsular contraction?

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I have a lot of experience with Alloderm as well as Flex HD and Allomax. These products have in my opinion, revolutionized the implant based breast reconstruction. I believe they do lessen capsular contraction. They also have been used in revision of breast augmentation complications, like rippling, capsular contraction and implant displacements. The problem in using them in cosmetic patients is the high cost which often is not reimbursed by insurance.

Alloderm, breast augmentation, breast enhancement, breast augmentation revsion, Dr. Whitfield, whitfieldplasticsurgery

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Breast impants which develop significant capsular contractures are difficult to deal with.  Alloderm has been used for multiple purposes for breast implant revsion for rippling  in cosmetic implant surgery.  Alloderm has been used for multiple years for freast reconstruction and it has been associated with a decrease in capsular contracture by some surgeons.  If you have recurring problems with implants the devices can be removed and if possible you could later have fat graft if several other factors are considered and you are found to be an approriate candidate.

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.