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With advances in medical technology the use of different types of medical devices, implant types and surgical techniques have been used to help in breast reconstruction as well as in revision of aesthetic breast surgery.
ADM in Breast Reconstruction
In breast reconstruction after breast cancer the use of ADM such as Alloderm has become a very common procedure. Alloderm is a regenerative ADM made of cadaveric dermal matrix that undergoes a special process preparing for use in reconstructive breast surgery. It assist by providing a strong matrix to the inferior pole of the reconstructed breast supporting the expander and later the breast implants functioning as an internal bra. It allows for quicker expansion of the tissue expanders shortening the time to achieve the total reconstruction process. It also adds tissue thickness to the thin tissues left after the breast tissue has been removed.
The ADM is a novel substance used today in breast surgery and is placed in the tissues at the appropriate position and sutured if needed for security. Then the ADM becomes incorporated into the patients tissue with ingrowth of blood vessels and other matrix substances to become as one with the patients own tissue.
ADM in Aesthetic Breast Surgery
In aesthetic breast surgery, such as breast augmentation and mastopexy (breast lift) with implants, a different reconstructive matrix is used. Strattice is a reconstructive tissue matrix mesh derived from porcine skin and processed for use in revision aesthetic breast surgery. As with Alloderm, Strattice is used to reinforce weakened tissues. Strattice tends to have a better tensile strength than Alloderm which tends to become lax over time.
As in the case of breast reconstruction, the Strattice is used as an internal bra in cases of aesthetic breast surgery when a “bottoming out” of the implants occurs due to weak lax tissues. The Strattice is placed and sutured between the inframammary fold and the released edge of the pectoralis muscle for support of the implant. Strattice is also used when thinning of the breast tissue causes visibility of the implants edges as well as when rippling of the implant is seen through the skin. Adding the ADM increases the thickness of the skin in that area reducing the visibility.
When implants are displaced medially, laterally or inferiorly due to improper surgical technique the ADM is placed surgically to re create the proper pocket dimensions for the implant improving the aesthetic appearance. Some of the latest reports are showing some promise regarding a reduced capsular contracture rate after use of ADM when disrupting and removing part of the capsule and replacing that section with the ADM. These studies will need more validation prior to using the ADM as an indication for treatment of capsular contraction after aesthetic breast surgery.
