Using acellular dermis creates an instant pocket, eliminating the need for expansion
you've decided on implant reconstruction, you may want to consider direct-to-implant or one-step reconstruction. Some
doctors are now using an acellular dermal matrix, such as AlloDerm®, DermaMatrix®,
or Tutoplast®--donated human tissue from which the cells have been removed--or Strattice™ (derived from porcine dermis) to facilitate this streamlined reconstructive
Typically, the chest muscle and
breast skin must be expanded over a period of several weeks to create a pocket of sufficient size to hold the implant. Alternatively,
stitching patches of acellular dermal matrix to the sides of the muscle or along the inframammary fold creates an instant
pocket and more complete coverage of exposed implant edges.
Direct-to-implant reconstruction offers three distinct
benefits over traditional implant reconstruction:
doesn't require expansion.
Women who combine this procedure
with skin-sparing, nipple-sparing mastectomy can complete their entire reconstruction in a single step.
Acellular dermal matrix integrates into a woman's healthy tissue.
It is important to note two issues about this procedure: although
the number of plastic surgeons who offer this type of reconstruction is growing, most still rely on traditional implant reconstruction
with expansion. Also, in some cases, women do need a secondary procedure to correct problems or improve cosmetic result.
Although breast reconstruction with AlloDerm or DermaMatrix is not yet widely performed (see the surgeon's links
below), acellular dermis has been used for years in other types of reconstructive surgeries (it's commonly used to repair
abdominal wall tears that can occur after TRAM reconstruction), and to replace missing or damaged skin and cover wounds. Like
other reconstruction methods, it makes good sense to research a direct-to-implant reconstruction procedure and your surgeon's
expertise before making a decision.
When consulting with a surgeon who reconstructs with AlloDerm or
DermaMatrix, be sure to clarify whether he/she performs single-step direct-to-implant or traditional
reconstruction with expansion.
Note: Although most surgeons prefer to place
an immediate implant under the muscle, some position the implant above the muscle (between the muscle and breast