Complicated breast augmentations, particularly secondary, may require dermal matrix coverage.  Revision augmentation that may require more soft tissue coverage from tissue thinning may be good candidates as well.  Various types of dermal matrices exist that differ in intraoperative preparation, method of storage and cost.2  

Types of Acellular Dermal Matrices

a) Alloderm®

AlloDerm® (LifeCell Corp., Branchburg, NJ) incorporates skin from a human cadaver that undergoes removal of the epidermis and other cells; this reduction in antigenicity provides for a negligible incidence of graft failure and tissue rejection. 3 The resultant product is a biological acellular matrix that favors cell repopulation and rapid revascularization.3 During the process of regeneration, Alloderm® is incorporated into the pre-existing tissue in four stages 1) Damaged tissue is targeted by circulating stem cells 2) Once damaged tissue is located, stem cells are deposited and proceed to adhere to the matrix 3) Differentiation into tissue-specific cell types occurs  4) A new matrix is formed from the differentiated cells which allows for tissue regeneration.4    AlloDerm® has been commonly employed for wound coverage,  fascial defect repair, and post-mastectomy breast reconstruction  uses , but its indications are rapidly expanding into a multitude of areas in which soft tissue camouflage is required for contour defects.

b) Strattice®

Strattice® is porcine dermis denuded of cells that contributes to the propagation of an antigenic response.   Strattice is a reconstructive tissue matrix that supports tissue regeneration used primarily in implant based/tissue expander reconstruction of the breast.6

 

c) DermaMatrix®

DermaMatrix® is human skin in which both the epidermis and dermis are removed from the subcutaneous layer of tissue in a process utilizing sodium chloride solution while preserving the original dermal collagen matrix. This reduces the incidence of rejection and inflammation.  Once DermaMatrix® is transferred to the patient; the collagen matrix is infiltrated by the host cells promoting neovasularization and fibroblast deposition.

Acellular cadaveric dermis has remarkably lower levels of inflammatory parameters; capsule fibrosis, vessel proliferation,  granulation tissue formation, fibroblast cellularity , chronic inflammatory changes, and foreign body giant cell inflammatory reaction than native breast capsules suggesting that acellular cadaveric dermis exhibits certain properties that may reduce formation of a capsule and therefore provides an excellent alternative to total submuscular implant placement.