Part III: Dermal Matrices in Breast Reconstruction and Augmentation
by Kenneth Hughes | Jul 25, 2014
Acellular Dermal Matrices for Breast Implant Reconstruction after Mastectomy
The use of a tissue expander or a breast implant in post mastectomy breast reconstruction can be a daunting task. Most reconstructive surgeons prefer the use of autologous tissue. Despite the fact that implant based reconstruction may appear to be technically easier, quicker and less costly, it is not without limitation when used in reconstructive procedures. Acellular dermal matrices have been used in single as well as staged reconstruction with good aesthetic results and low complication rates. Typically, the tissue expander/
breast implant is positioned just below the pectoralis major muscle to cover its superior and medial poles. For coverage of the lateral and inferior poles either additional muscles are elevated (serratus anterior) contributing to another layer between the skin and implant hence lowering the incidence of contour irregularities and implant exposure, or subcutaneous tissue only is used.
In an attempt to reduce the time needed for the entire reconstructive process by eliminating the need for tissue expansion, Dermal matrices have been used to create pockets to completely enclose the breast implant. A sling was used to anchor the lower pole of the pectoralis major muscle. For the most part, postoperative results demonstrated lower-pole projection, good symmetry, and a volume match compared with preoperative size. This approach enables easy manipulation of the implant pocket to allow for optimal cosmetic breast contouring and maintenance of thicker muscle coverage in the medial and upper poles as well as providing the support necessary to sustain a strong lower pole. Another distinctive method is the use of an inferolateral Alloderm hammock which attaches to the serratus anterior laterally and rectus abodminis fascia inferiorly to create an implant pocket in which it is easy to control implant position.
