Alloderm in Breast Reconstruction: Efficacy and Morbidity
In recent years, the use of acellular dermal matrices (i.e. Alloderm) has significantly changed the manner in which breast reconstruction and breast revision surgery are performed.
Using acellular dermal matrices (ADMs) allows:
1) improved control over placement or creation of the inframammary fold
2) better control over breast contour
3) reduced absolute number of expander fills required
4) reduced time to complete expansion and eventual implant exchange.
5) enhanced soft tissue coverage, protecting implants under mastectomy flaps.
Use of ADMs has also been shown to improve the management of threatened breast implants, reduce the need for explantation, and possibly even reduce the incidence of capsular contracture. However, there are also known potential complications in this technique including seroma, hematoma, and both major and minor infection. A recent article reviewed the use of acellular dermal matrices for this purpose*. The authors looked at previous studies reporting results of two-stage expander/implant reconstruction using an acellular dermal matrix sling or those comparing ADM use to traditional full submuscular coverage.
What the authors found in this review is:
1) the efficacy and safety of procedures using acellular dermal matrix are equivalent to those using full submuscular coverage.
2) of all the known complications, the only complication significantly more frequent in the ADM use groups was an increased incidence of seroma.
3) infection rates were noted to be relatively equivalent between the two breast reconstruction techniques.
4) in cases of skin flap or incisional breakdown, incorporated ACM has the ability to protect the underlying breast implant.
5) use of ADM allows larger expander fill volumes during the initial operation, and fewer total fills needed to achieve full expansion.
*(Sbitany and Serletti, Acellular Dermis-Assisted Prosthetic Breast Reconstruction: A Systematic and Critical Review of Efficacy and Associated Morbidity, Plas Reconstr Surg, Vol 128, No 6, Dec 2011, p1162)