The use of acellular dermal matrices, available since 1994, has become more widely accepted in abdominal wall and breast reconstruction procedures and its indications continue to expand.1 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  

1) 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® (LifeCell Corp., Branchburg, NJ) is porcine dermis denuded of cells that contributes to the propagation of an antigenic response.  This proprietary process causes a marked reduction in 1, 3 alpha galactose epitope, a major component of the xenogeneic rejection 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® (Synthes CMF, West Chester, PA) 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. It is important to note that DermaMatrix® is used only for homologous tissue; however it has a wide variety of applications including nasal reconstruction, lower eyelid reconstruction, cleft palate repair, abdominal wall repair and breast reconstruction post mastectomy. DermaMatrix® has the distinct advantage of rapid rehydration, bacterial inactivation and it does not necessitate the need for refrigerated storage. 7  

A study by Becker et al2 compared the use of AlloDerm® and DermaMatrix® in 30 patients (50 breasts) who had immediate expander-based breast reconstruction. Patients were followed up for a mean of 6.7 months. It was found that both dermal matrices were well incorporated and histological examination showed proof of neovascularization. There was a 4% complication rate attributed to wound infection and seroma formation, however no significant dissimilarities were observed in the complication profiles of both groups. The results of this study suggest no important differences among the use of AlloDerm® as opposed to DermaMatrix®. Basu et al8 demonstrated that based on histopathologic analysis, 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 in breast reconstructive procedures.

Dermal Matrices in Breast Augmentation Articles

Part I: Types of Dermal Matrices in Breast Augmentation
Part II: Dermal Matrices in Breast Augmentation
Part III: Complications of Dermal Matrices in Breast Augmentation
Part IV: Dermal Matrices in Breast Reconstruction
Part V: Dermal Matrices in Breast Augmentation Summary

Click on the links below to view a few of the chapters written by Dr. Hughes

Chapter 1: Preoperative Workup in the Plastic Surgery Patient
Chapter 2: Photography in Plastic Surgery
Chapter 3: Facelift
Chapter 4: Fat Grafting
Chapter 5: Fillers
Chapter 6: The Role of Dermal Matrices in Breast Augmentation
Chapter 7: Scar Revision in Plastic Surgery

Or Continue on to Breast Augmentation Photo Galleries

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