Acellular Dermal Matrix in Reconstructive Breast Surgery

Abstract

Background:Acellular dermal matrices (ADMs) in plastic surgery have become increasingly popular particularly for breast reconstruction. Despite their advantages, questions exist regarding their association with a possible increased incidence of complications. We describe a collective experience of plastic surgeons’ use of ADMs in reconstructive breast surgery using an internet-based survey.Methods:Members of the American Society of Plastic Surgeons were recruited through voluntary, anonymous participation in an online survey. The web-based survey garnered information about participant demographics and their experience with ADM use in breast reconstruction procedures. After responses were collected, all data were anonymously processed.Results:Data were ascertained through 365 physician responses of which 99% (n = 361) completed the survey. The majority of participants were men (84.5%) between 51 and 60 years (37.4%); 84.2% used ADM in breast reconstruction, including radiated patients (79.7%). ADM use was not favored for nipple reconstruction (81.5%); 94.6% of participants used drains, and 87.8% administered antibiotics postoperatively. The most common complications were seroma (70.9%) and infection (16%), although 57.4% claimed anecdotally that overall complication rate was unchanged after incorporating ADM into their practice. High cost was a deterrent for ADM use (37.5%).Conclusions:Plastic surgeons currently use ADM in breast reconstruction for both immediate and staged procedures. Of those responding, a majority of plastic surgeons will incorporate drains and use postoperative antibiotics for more than 48 hours.

Complication Rates With Human Acellular Dermal Matrices: Retrospective Review of 211 Consecutive Breast Reconstructions

“…11 HADMs are processed from cadaveric donor-derived skin. Generally, the epidermal layer of skin is removed, followed by decellularization of the remaining tissue to minimize the risk of immunogenic response upon transplant.…”

“…3,6,11 ADM-assisted breast reconstruction can also allow for a prepectoral placement of the breast implant especially with advanced mastectomy techniques such as nipple sparing (NS). Before these advances, the expanders were traditionally placed in the submuscular pocket because of concerns with thin and poorly vascularized flaps.…”

Acellular Dermal Matrix (Permacol®) for Heterologous Immediate Breast Reconstruction after Skin-Sparing Mastectomy in Patients with Breast Cancer: A Single-Institution Experience and a Review of the Literature

“…Whereas in 2010, 50% of plastic surgeons reported using ADMs in their daily practice for breast reconstruction, and in 2015, 84.2% of plastic surgeons in the United States reported using it routinely (8, 12). However, the literature indicates that there is a lack of randomized controlled trials evaluating the outcome of ADM-assisted breast reconstruction.…”

“…Despite a lack of randomized controlled studies to analyze outcomes of breast reconstruction with ADMs, 84.2% of members of the American Society of Plastic Surgeons reported in a survey in 2015 that they used ADMs in breast reconstructions routinely (8). …”

Radiologic-Pathologic Correlation: Acellular Dermal Matrix (Alloderm®) Used in Breast Reconstructive Surgery

“…[3]” Illustrations of how ADM is used at the time of tissue expander placement or around the implant have been described. [13] Various ADMs are available[34567] including those from cadaveric human tissue (Alloderm ® , AlloMax™, FlexHD ® , DermACELL ® ), porcine tissue (Strattice™, Permacol™, Braxon ® ), bovine tissue (SurgiMend ® ), and bovine pericardium tissue (Veritas ® ).…”