Implant-Based Breast Reconstruction with Allograft

Abstract

Breast reconstruction with implant and AlloDerm enables the surgeon to create a submuscular pocket large enough to place a fully inflated breast implant. Interposition of a lower-pole internal sling, to increase the capacity of the pectoralis major pocket while providing immediate ability to achieve full or subtotal prosthetic fill and optimal aesthetic breast contouring and to maintain thicker muscle coverage in the upper and medial pole areas and stronger lower pole support, would obviate many of the current disadvantages to implant reconstruction.

Acellular Dermal Matrix for Optimizing Outcomes in Implant-Based Breast Reconstruction: Primary and Revisionary Procedures

“…Two patients required revisionary surgery; one patient underwent implant exchange as she desired a larger implant and the other underwent nipple reconstruction to regain nipple projection after nipple flattening. Our results suggest that ADM-assisted direct-to-implant breast reconstruction can be reliably accomplished after NASM and are in concordance with other published series of ADMassisted direct-to-implant reconstruction (Breuing & Warren, 2005;Breuing & Colwell, 2007;Cassileth et al, 2011;Salzberg, 2006;Salzberg et al, 2011;Topol et al, 2008;Zienowicz & Karacaoglu, 2007).…”

“…More recently, ADMs have been used at the inferolateral pole after capsulotomy or capsulectomy to help correct and prevent capsular contracture (Breuing & Colwell, 2007;Hartzell et al, 2010;Spear et al, 2011). In ADM-assisted implant-based primary reconstructions, a low rate of capsular contracture (0%-2%) has been observed (S. Becker et al, 2009;Bindingnavele et al, 2007;Breuing & Colwell, 2007;Namnoum, 2009;Salzberg, 2006;Salzberg et al, 2011;Spear et al, 2008;Zienowicz & Karacaoglu, 2007), suggesting that ADMs may help prevent or reduce the risk of capsular contracture; hence, the rationale for using ADMs for the correction and prevention of capsular contracture. Animal and clinical studies suggest that ADMs may prevent capsular contracture by minimizing the inflammatory response, thereby reducing capsule formation around implants (Basu et al, 2010;Komorowska-Timek et al, 2009;Orenstein et al, 2010;Stump et al, 2009;Uzunismail et al, 2008).…”

“…The use of ADM to extend the pectoralis major muscle at the lower pole to provide complete soft tissue coverage of the implant (Figure 1) has been previously described (Breuing & Warren, 2005;Salzberg, 2006;Zienowicz & Karacaoglu, 2007). NASM is performed via a periareolar incision (Figures 2A & 2B).…”

“…Immediate direct-to-implant breast reconstruction after skin-sparing or NASM (Breuing & Warren, 2005;Breuing & Colwell, 2007;Cassileth et al, 2011;Salzberg, 2006;Salzberg et al, 2011;Topol et al, 2008;Wang et al, 2008;Zienowicz & Karacaoglu, 2007) is gaining popularity as a viable alternative to immediate expander/implant reconstruction which is the current standard of care for implant-based breast reconstruction postmastectomy (American Society of Plastic Surgeons [ASPS], 2009). While both approaches allow immediate creation of the breast mound offering pyschologic and aesthetic benefits, the direct-to-implant approach allows maximal use of the preserved mastectomy skin at the time of reconstruction.…”

Biological and Synthetic Mesh Use in Reconstructive Surgery in Patients With Breast Cancer

“…In the original report of Breuing as well as in five subsequent randomized studies the effectiveness and success of immediate reconstruction when using ADM were proven [38,41,42,[47][48][49]. In these retrospective studies, the overall incidence of complications was between 6,9% and 25%.…”