The use of acellular dermal matrices in breast reconstruction is becoming more popular in part due to the better cosmetic and psychological outcomes associated with their use.8,9 Their benefits in primary prosthetic breast reconstruction which include a lower incidence of capsular contracture, improved implant coverage and support and better management of implant position have been highlighted in numerous studies.2,9-21 Allogenic acellular matrices can be used in both immediate and delayed single-stage expander-based reconstruction aiding in reconstruction of the inframammary fold, providing much needed inferolateral prosthesis coverage and eliminating donor-site morbidities leading to a reduction in muscle dysfunction and pain as well as an early recovery period.2,22 Furthermore it permits immediate implant placement post mastectomy through expansion of the submuscular pocket volume.9,10,14,22 One factor however that may serve as a deterrent for the use of acelluar dermal matrices in breast reconstruction procedures is its high cost which may range anywhere from $3,536 to $4,856 per breast.23 For the most part, aesthetic outcomes supersede cost as demonstrated in a study conducted by Salzberg9 were AlloDerm® was used in 49 patients (76 breasts) who underwent immediate reconstruction to provide total coverage over the prosthesis alleviating the need for breast expansion prior to placement of an implant and to minimize muscle dissection. The outcome was said to be favorable with good symmetry.

6) Acellular Dermal Matrices for Secondary Augmentation

Some of the most complicated and challenging predicaments to correct are deformities of the breast following breast augmentation and augmentation mastopexy(breast lift). They are of the most complex procedures that a plastic surgeon may face with a significantly higher rate of complications compared to primary procedures, perhaps due to the fact that there may be encapsulation or stretch of breast tissue caused by excessive scarring or thinning attributed to the use of large implants.23,35 In a 2 year study where 78 patients who underwent breast augmentation and augmentation mastopexies  with acellular dermal matrices were enrolled and followed up for 12 months, no capsular contractures were reported although, two complications did occur; implant malposition and hematoma formation. This data suggests that with the use of acellular dermal matrices the capsular contracture rate following revision breast augmentation and augmentation mastopexy procedures is markedly reduced. 35 In a more recent retrospective study by Hartzell et al23 a single surgeons’ experience using acellular dermal matrix  following breast augmentation from 2005 to 2009 was analyzed during which 23 patients (38 breasts) were included. Of the 38 breasts, implant malposition was reported in 22 and surface irregularities in 28, with both appearing in 12 patients. Following their revision procedure, 20 patients showed improvement in the aesthetic appearance of their breasts, 3 patients required an additional procedure and 1 patient was found to have incurred an infection for which the human acellular dermal matrix was removed. In the end, the authors proclaim the use of human acellular dermal matrix a safe alternative for correction of breast deformities following augmentation.

Beverly Hills and Los Angeles Breast Augmentation at Hughes Plastic Surgery
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