Using acellular dermis creates an instant pocket, eliminating the need for expansion
If
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).
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 the exposed implant edges.
Direct-to-implant reconstruction offers three
distinct benefits over traditional implant reconstruction:
Women who combine
this procedure with prophylactic subcutaneous (skin-sparing)mastectomy and nipple-sparing mastectomy can complete their
entire reconstruction in a single step.
Acellular dermal matrix
integrates into a woman's healthy tissue.
Two
things you should know about this procedure: although the number of reconstructive surgeons who offer this procedure 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, 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 skin).
