Are There Any Significant Advantages to Using Alloderm in Delayed Bilateral Breast Reconstruction?

Considering 2 step tissue-expander surgery with full muscle coverage, an anotomical cohesive gel implant and no Alloderm versus partial muscle coverage with Alloderm and a round cohesive gel implant. I want the most natural results with minimal impact on my upper body strength.

Doctor Answers 4

Are there any significant advantages to using acellular dermal matrix in delayed breast reconstruction?

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Hello!  Thank you for your question!  The use of the acellular dermal matrix has grown in its applications and use in plastic & reconstructive procedures, and growing. 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 is placed on the inside, not on your 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. Packages 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.  Hope that this helps!

Alloderm for delayed breast reconstruction with tissue expanders

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In my practice, I prefer to use an acellular dermal matrix product (such as Alloderm or FlexHD) in conjunction with tissue expanders for breast reconstruction.  This allows the expander to sit in a more anatomical location while partially releasing the pectoralis muscle.  Expansion can be completed faster and the overall result I have been pleased with.  Some patients are better suited for total muscle coverage, but this depends on their overall health, etc...Talk to your surgeon about both options and they will explain what they are most comfortable with.

Michael A. Fallucco, MD, FACS
Jacksonville Plastic Surgeon

Advantages of Alloderm in breast reconstruction

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Before the use of Alloderm became commonplace, total muscle coverage was the norm. There are several reasons why Alloderm has changed how we do reconstruction now: 1. Expansion of the muscles that Alloderm replaces can be painful and slow; 2. It is very difficult to get a nice round contour over the lower part of the breast with total muscle coverage regardless of the shape of the implant; 3. The time interval for expansion is usually less; and 4. there seems to be a lower chance of capsular contracture around the implant with Alloderm.

Breast reconstruction and alloderm

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I prefer to release the muscle so that the expander or implant is positioned properly in the pocket and also has coverage of the lower pole jsut in case the skin breaks down.  This is why I use the alloderm in all these types of procedures.

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