Acellular dermal matrices (ADM) such as Alloderm and Strattice have become increasingly popular in both revision breast surgery and breast reconstruction during the last few years. This is partially due to an increase in the number of revision breast implant cases that are being seen (in my office) as well as to the ever increasing frequency of two-stage tissue expander, implant-based breast reconstruction. During these procedures, acellular dermal matrices are utilized (primarily during the first stage) to reinforce and provide coverage of the lower pole of the device. A new study provided a retrospective review of user experience with techniques in breast reconstruction at two New York hospitals (Glasberg and Light, Alloderm and Strattice in Breast Reconstruction: A Comparison and Techniques for Optimizing Outcomes. Plast Reconstr Surg, Vol 129, No 6, June 2012, p1223.)
The authors reviewed data from 96 patients (126 reconstructive procedures) who had Alloderm placed, and 90 patients (144 reconstructive procedures) who had Strattice placed. The Alloderm group did have a significantly higher incidence of seroma formation. However, with respect to other complications that occurred after surgery (such as infection, and extrusion), rates were not significantly different. During the second stage operation (when the expander was removed and the permanent implant placed, tissue biopsies were obtained to evaluate microscopically both the Alloderm and Strattice grafts. Both were noted to be well incorporated with re-vascularization present, indicating in growth of the surrounding tissues. Interestingly, the pathology also showed an absence of synovia-like metaplasia at the ADM-tissue expander interface like was clearly seen at the breast capsule-tissue expander interface. This served as a pathologic indication that the two tissue interfaces were distinctively different. Further, the authors noted a relatively low incidence of capsular contracture in both groups (2-3%) compared with other previous studies which show clinically significant capsular contracture rates of of 10-20% by about 1-2 years after reconstruction in patients without ADM. This provides additional support to the concept that placement of ADMs during breast reconstruction (and possibly even in breast revision cases) can reduce the clinical incidence of developing capsular contracture.
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