Alloderm, and other similar ADM products including Strattice and FlexHD, are now being used routinely in breast reconstruction.
ADM stands for “acellular dermal matrix”. It is a biologic mesh-like material derived from animals or donated (cadaveric) human skin. Alloderm is a human product and is the most widely used ADM. It is used in many different types of reconstructive surgery including breast reconstruction.
Before being packaged for use, the Alloderm undergoes a multi-step process that removes all the cells that can lead to tissue rejection: even though it comes from another person, your body does not reject Alloderm because the immune cells are removed. Alloderm essentially acts as a scaffold and over time, the patient’s own cells grow into it.
Since it is a human (cadaveric) product, the U.S. Tissue Bank rigorously screens all tissue donors’ medical records. All donors must be negative for Syphilis, Hepatitis B and C, and HIV 1 and 2. AlloDerm grafts are also examined under the microscope before and after processing to rule out contamination.
ADM is frequently used in implant-based breast reconstruction (and has been for years). The tissue expander or implant is either placed on top or underneath the pectoralis (chest) muscle. The pec muscle cannot cover the entire implant. The ADM is used to cover the lower part of the implant that is not covered by muscle, or as a wrap or drape over the implant when it is placed on top of the muscle (“prepectoral”).
Although ADMs are not FDA approved for use in breast surgery, there are currently studies underway to evaluate the overall benefits and risks of the product.
– Stabilizes the implant in position.
– Allows for complete implant coverage.
– Decreases capsular contracture (implant hardening).
– Can allow the creation of a full-sized breast when the tissue expander/implant reconstruction is performed at the same time as the mastectomy.
– Once incorporated by the body, resists infection as well as the patient’s “natural” tissue.
– Like anything that is implanted in the body, there is an initial (low) risk of infection (until it becomes incorporated).
– Alloderm can cause temporary redness in the skin (“red breast syndrome”).
– Costly but usually covered by insurance.
Many plastic surgeons, including myself, use an ADM routinely when performing breast reconstruction with tissue expanders and implants.
Author: Dr. Minas Chrysopoulo
Alloderm, and other similar ADM products including Strattice and FlexHD, are now being used routinely in breast reconstruction.
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