Does the Addition of Alloderm Make Reconstruction Less Painful?

Question

i am having a tough time with the expanders...Ive tried OTC meds, physio etc. I feel extremely tight and uncomfortable. I have expanders in after a skin sparring double mastectomy. Would having alloderm added to my final exchange surgery give me some relief from the tight feeling?

Kenneth Hughes, MD · Answer

Alloderm will not help with the tight feeling.  This pain is primarily the result of skin and muscle stretch.  If the original surgery was performed and the serratus anterior was elevated for total submuscular coverage of the expander, this may hurt a little more than if Alloderm had been placed for an inferior sling. 

	 

	      At this point, having a surgery to place Alloderm is probably not worth the risks of surgery and the additional pain. 

	 

	          Other ways to manage the pain of tissue expansion include having the intervals between expansion increased.  However, reducing the amount of fluid added per session is probably the best way to reduce the pain.  This pain will be less after the maximum volume is achieved and the implant is placed.

	 

	          Good luck with your reconstruction.

Steven Wallach, MD · Answer

I doubt very much that the alloderm used to cover the lower pole of the tissue expander would help with post-op discomfort.  But you should see your doctor to make sure this is routine post-op pain.

Mark Schwartz, MD · Answer

I do not think that adding Alloderm at the time of your tissue expander to permanent implant exchange would change your pain symptoms.  I have however observed less postoperative pain in immediate breast reconstruction patients who have alloderm inserted as part of the initial procedure.  The Alloderm allows for less chest muscle surgery (namely the serratus muscle) since it covers the implant along with the pectoralis muscle.  It may also allow for easier lower breast expansion which can lead to a more natural result. 

	The tight feeling you are experiencing will most likely resolve with time while the skin is being stretched.  I would encourage you to speak with your plastic surgeon as he or she is most suited to help you while you are waiting for the tight feeling to resolve.  Good luck.

C. Bob Basu, MD, MPH, FACS · Answer

Acellular dermal matrix products like AlloDerm or Strattice are utilized at the time of tissue expander placement.   These sheets of collagen help to expedite skin expansion, ease the pain of expansion as compared to tradition submuscular techniques, and facilitate a more aesthetically pleasing breast mound.   Since you already have a tissue expander in place, I really don't see a role to add AlloDerm now.  Give time for your skin to "settle" and proceed with your implant exchange as per your plastic surgeon's timeline/recommendations.  Best wishes.

	Dr. Basu

	Houston, TX

Does the Addition of Alloderm Make Reconstruction Less Painful?

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