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Regenerative Human Acellular Tissue Matrix (AlloDerm®) as Tissue Supplement in Immediate Breast Reconstruction Postmastectomy - A Technical Perspective.
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LifeCell Clinical Monograph Series, 2005.
Scott L. Spear, MD
Professor and Chief, Plastic Surgery
Georgetown University School of Medicine
Washington, DC
Karl H. Breuing, MD
Assistant Professor of Surgery,
Harvard Medical School
Brigham & Women’s Hospital
Boston, MA
Richard J. Zienowicz, MD
Associate Professor of Surgery,
Brown University School of Medicine
Rhode Island Hospital
Providence, RI
C. Andrew Salzberg, MD
Associate Professor of Plastic Surgery,
New York Medical College
Valhalla, NY
Abstract:
Immediate breast reconstruction is currently viewed as the standard of care for women who have had mastectomy for breast cancer. This is due largely to improvements in reconstructive techniques and in changing attitudes. There is no longer a concern that adjuvant therapy must be delayed during recovery after immediate reconstruction or that implant reconstruction masks detection of local recurrence. Furthermore, immediate reconstruction has several clinical advantages over delayed reconstruction. First, it conserves native skin and soft tissue quality, which could lead to superior cosmesis. In delayed reconstruction, scar tissue formation as a result of healing inevitably compromises soft tissue quality. Second, it improves psychological outcome by preserving positive body image and reducing emotional stress during the postoperative period. Third, immediate reconstruction reduces the number of surgeries and contributes to less morbidity.
Immediate breast reconstruction with implants or tissue expanders is currently one of the most commonly used surgical techniques. The improved aesthetic outcome is attributed to advances in breast implant designs and in the surgical technique. However, attaining total muscle coverage of the implant/expander such that the prosthesis is supported and held in place in the mastectomy pocket remains a key technical challenge. Lack of total coverage of the implant/expander, especially at the breast lower pole, could lead to the postreconstruction problems of bottoming-out and implant exposure.
The magnitude of muscle loss during mastectomy and the quality of the remaining muscle to a large extent determine the feasibility of obtaining total muscle coverage of the prosthesis. When total muscle coverage is not possible, coverage could be attempted with the mastectomy skin envelope. Covering the implant with only the skin envelope, however, does not provide implant support and may lead to bottoming-out and implant exposure if skin loss occurs. Alternatively, autologous tissue taken from the latissimus dorsi is sometimes used to supplement the muscle deficit at the breast lower pole. This is associated with its own set of problems: donor site morbidity, healing, scarring, and risks of infection and necrosis of the latissimus tissue. The problems of using autologous tissue could be obviated by using a tissue substitute to supplement the muscle deficit such that total coverage of the implant/expander is obtained. AlloDerm® (LifeCell Corporation, Branchburg, NJ), a regenerative human acellular tissue matrix, is a highly successful tissue replacement that has been shown to resist infection, to rapidly repopulate and revascularize, and to remodel and transition into host tissue thereby restoring native tissue function. AlloDerm exhibits remarkable versatility regardless of the type of tissue it is replacing and has been used in numerous physiologic sites and body systems. AlloDerm, therefore, is a rational choice for supplementing the muscle deficit encountered during implant/expander breast reconstruction. The use of AlloDerm to cover and support the prosthesis at the breast lower pole is presented here together with a summary of the initial clinical experience. |
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