Acellular dermal matrices: Use in reconstructive and aesthetic breast surgery

Sheina A Macadam, Peter A Lennox, Sheina A Macadam, Peter A Lennox

Abstract

Acellular dermal matrices (ADMs) were first described for use in breast surgery in 2001. Since this initial report, ADMs have become an increasingly common component of implant-based breast procedures. ADMs have shown promise for use in both aesthetic and reconstructive breast surgery; however, concerns about their use remain because of the significant costs associated with these products. The present article reviews the history of ADM use in breast surgery and the outcomes reported to date. Common techniques for placement of ADMs in aesthetic revisionary and breast reconstruction surgery are provided, and use in the setting of chest wall irradiation and capsular contracture is discussed. Finally, the authors comment on the cost implications of these products in the Canadian and American health care systems.

Keywords: Acelluar dermal matrices; Breast aesthetic surgery; Breast reconstruction; Economic analysis.

Figures

Figure 1)
Figure 1)
Bilateral direct-to-implant breast reconstruction.AA 60-year-old patient who underwent nipple-sparing direct-to-implant reconstruction using AlloDerm (LifeCell Corporation, USA) 6 cm × 16 cm and round silicone gel implants (Style 15–304g Allergan [Allergan Inc, USA]).BPostoperative photograph
Figure 2)
Figure 2)
AAcellular dermal matrix coverage of implant (anteroposterior).BAcellular dermal matrix coverage of implant (lateral). m Muscle
Figure 3)
Figure 3)
Elevation of the pectoralis muscle in preparation for placement of implant and acellular dermal matrix
Figure 4)
Figure 4)
Fixation of acellular dermal matrix to chest wall and inframammary fold using three-point suture. m Muscle
Figure 5)
Figure 5)
Breast reconstruction using acellular dermal matrices in the setting of chest wall irradiation.AA 46-year-old patient who underwent skin-sparing mastectomies and tissue expander/AlloDerm (LifeCell Corporation, USA) reconstruction on the right and direct-to-implant reconstruction using AlloDerm and a shaped, cohesive silicone gel implant on the left (Style FX-410g Allergan [Allergan Inc, USA]).BPostoperative photograph taken one year after right-sided radiation and subsequent implant exchange for Style FX-450 (Allergan Inc, USA)
Figure 6)
Figure 6)
Acellular dermal matrix coverage of tissue expander (anteroposterior). m Muscle
Figure 7)
Figure 7)
Medial placement of acellular dermal matrix to correct symmastia
Figure 8)
Figure 8)
Preoperative markings in correction of symmastia (red-shaded areas correspond to medial implant malposition)
Figure 9)
Figure 9)
Intraoperative placement of acellular dermal matrix in correction of symmastia
Figure 10)
Figure 10)
Placement of acellular dermal matrix to correct symmastia (dotted lines represent previous medial malposition). m Muscle
Figure 11)
Figure 11)
Placement of acellular dermal matrix to correct rippling
Figure 12)
Figure 12)
A 27-year-old patient who underwent bilateral mastectomies and immediate reconstruction using tissue expanders and subsequent textured round silicone gel implants (500 g). She experienced inferior displacement with blunting of the inframmamary fold and medial displacement of the left implant (AandB). She underwent conversion to smooth gel implants (500 g) and insertion of AlloDerm (LifeCell Corporation, USA) 6 cm × 16 cm bilaterally to provide inferior and medial support (CandD). Bilateral inferior capsulorrhaphies were also performed
Figure 13)
Figure 13)
Correction of bottoming-out with acellular dermal matrix. m Muscle
Figure 14)
Figure 14)
Correction of bottoming out with acellular dermal matrix using the ‘gutter’ technique. m Muscle
Figure 15)
Figure 15)
Direct-to-implant AlloDerm (AD, LifeCell Corporation, USA) reconstruction and two-stage non-AD reconstruction calculator. Upper right box with costs in green show expected costs for direct-to-implant (one stage) versus traditional two-stage reconstruction after inputting weighted averages for direct-to-implant outcomes from Table 1 and the Core Study outcomes for two-stage, non-AD outcomes from Table 2. Outcome probability for exposure with salvage and hematoma probability estimated by expert opinion

Source: PubMed

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