Acellular Dermal Matrices for Breast Reconstruction after Mastectomy with Tissue Expander/Implant

The use of a tissue expander or an 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. 12,14 Typically, the tissue expander/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 (pectoralis minor or 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.2,14,22,29,30
In an attempt to reduce the time needed for the entire reconstructive process by eliminating the need for tissue expansion, Breuing and Warren 10 utilized a technique in which subpectoral-sub-AlloDerm® pockets were created to completely enclose the breast implant. An AlloDerm® 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. In a study of 30 immediate implant-breast reconstructions with human acellular dermal matrix over an 8 month mean follow up period, in which Zienowicz and Karacaoglu14 sewed AlloDerm® to the lower pole of the released pectoralis major superiorly, the serratus anterior flap laterally and the chest wall inferomedially, a 0% complication rate (no symmastia, bottoming-out deformity or rippling) was reported. 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. This was used in 67 breasts; 30 silicone implant reconstructions, 23 revisional implant reconstructions for capsular contracture after capsulectomy, 10 immediate expander-implant reconstruction and 4 delayed expander-implant reconstructions. No complications were reported over a 6 month to 3 year follow up period and patients were satisfied with the final outcome. 1

Continue on to other 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

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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

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