Download PDF
Semin Plast Surg 2019; 33(04): 229-235
DOI: 10.1055/s-0039-1696986
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evidence for the Use of Acellular Dermal Matrix in Implant-Based Breast Reconstruction

Paula R. Gravina
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Rowland W. Pettit
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Matthew J. Davis
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Sebastian J. Winocour
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Jesse C. Selber
2   Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
17 October 2019 (online)

Also available at
    Permissions and Reprints

Abstract

Acellular dermal matrices (ADMs) are tissue grafts that have been specially processed to remove all cellular components. These machined biological scaffolds have become popular in a variety of surgical settings due to their rapid incorporation into living tissue. As ADMs are highly malleable and cause minimal inflammation, they have come to serve as a useful tool in implant-based breast reconstruction procedures. The major benefits of using an ADM in this setting include superior initial breast contouring, decreased risk of capsular contracture after implant insertion, and consistent sustained positioning of the reconstructed breast. Despite these advantages, these tissue grafts are foreign to the host, and postoperative complications following ADM insertion, including infection and seroma, have been well documented. When considering using ADMs in this setting, it is important to first consider patient-specific factors that could preclude their use, such as low body mass index, small breasts, or a history of radiation exposure to the breast tissue. ADM grafts are also expensive, which may present another barrier to their use. Review of the literature ultimately suggests a continued role for ADMs in implant-based breast reconstruction, and continued research in this field is warranted.

Keywords

acellular dermal matrix - breast reconstruction - implant-based reconstruction

Disclosures

None of the authors of this manuscript have a financial interest in any of the products, devices, or drugs mentioned herein.


 

  • References

  • 1 Salzberg CA. Nonexpansive immediate breast reconstruction using human acellular tissue matrix graft (AlloDerm). Ann Plast Surg 2006; 57 (01) 1-5
    CrossrefPubMedSearch in Google Scholar
  • 2 Medina CR, Bradley KM, Denne J. , et al. Acellular cadaveric dermis (Alloderm) for ventricular coverage after a gunshot wound. Inj Extra 2008; 39: 123-126
    CrossrefPubMedSearch in Google Scholar
  • 3 Buinewicz B, Rosen B. Acellular cadaveric dermis (AlloDerm): a new alternative for abdominal hernia repair. Ann Plast Surg 2004; 52 (02) 188-194
    CrossrefPubMedSearch in Google Scholar
  • 4 Spear SL, Parikh PM, Reisin E, Menon NG. Acellular dermis-assisted breast reconstruction. Aesthetic Plast Surg 2008; 32 (03) 418-425
    CrossrefPubMedSearch in Google Scholar
  • 5 Liu D. New plastic surgery statistics and breast reconstruction trends | ASPS. 2017 [cited October 23, 2018]. Available at: https://www.plasticsurgery.org/news/blog/new-plastic-surgery-statistics-and-breast-reconstruction-trends . Accessed August 19, 2019
    PubMedSearch in Google Scholar
  • 6 Lennox PA, Bovill ES, Macadam SA. Evidence-based medicine: alloplastic breast reconstruction. Plast Reconstr Surg 2017; 140 (01) 94e-108e
    CrossrefPubMedSearch in Google Scholar
  • 7 Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg 2015; 150 (01) 9-16
    CrossrefPubMedSearch in Google Scholar
  • 8 Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol 2007; 25 (33) 5203-5209
    CrossrefPubMedSearch in Google Scholar
  • 9 Kamali P, Koolen PGL, Paul MA, Medin C, Shermerhorn M, Lin SJ. Regional and national trends over 20 years in one-stage vs two-staged implant based breast reconstruction. Plast Reconstr Surg 2015; 136: 122
    PubMedSearch in Google Scholar
  • 10 2016 Plastic Surgery Statistics Report on Reconstructive Demographics. Available at: https://www.plasticsurgery.org/news/plastic-surgery-statistics?sub=2016+Plastic+Surgery+Statistics . Accessed August 19, 2019
    PubMed
  • 11 Cheng A, Saint-Cyr M. Comparison of different ADM materials in breast surgery. Clin Plast Surg 2012; 39 (02) 167-175
    CrossrefPubMedSearch in Google Scholar
  • 12 Uzunismail A, Duman A, Perk C, Findik H, Beyhan G. The effects of acellular dermal allograft (AlloDerm®) interface on silicone-related capsule formation—experimental study. Eur J Plast Surg 2008; 31: 179-185
    CrossrefPubMedSearch in Google Scholar
  • 13 Komorowska-Timek E, Oberg KC, Timek TA, Gridley DS, Miles DAG. The effect of AlloDerm envelopes on periprosthetic capsule formation with and without radiation. Plast Reconstr Surg 2009; 123 (03) 807-816
    CrossrefPubMedSearch in Google Scholar
  • 14 Stump A, Holton III LH, Connor J, Harper JR, Slezak S, Silverman RP. The use of acellular dermal matrix to prevent capsule formation around implants in a primate model. Plast Reconstr Surg 2009; 124 (01) 82-91
    CrossrefPubMedSearch in Google Scholar
  • 15 Basu CB, Leong M, Hicks MJ. Acellular cadaveric dermis decreases the inflammatory response in capsule formation in reconstructive breast surgery. Plast Reconstr Surg 2010; 126 (06) 1842-1847
    CrossrefPubMedSearch in Google Scholar
  • 16 Salzberg CA, Ashikari AY, Berry C, Hunsicker LM. Acellular dermal matrix-assisted direct-to-implant breast reconstruction and capsular contracture: a 13-year experience. Plast Reconstr Surg 2016; 138 (02) 329-337
    CrossrefPubMedSearch in Google Scholar
  • 17 Spear SL, Murphy DK, Slicton A, Walker PS. ; Inamed Silicone Breast Implant U.S. Study Group. Inamed silicone breast implant core study results at 6 years. Plast Reconstr Surg 2007; 120 (07) (Suppl. 01) 8S-16S , discussion 17S–18S
    PubMedSearch in Google Scholar
  • 18 Mofid MM. Acellular dermal matrix in cosmetic breast procedures and capsular contracture. Aesthet Surg J 2011; 31 (7, Suppl): 77S-84S
    CrossrefPubMedSearch in Google Scholar
  • 19 Orenstein SB, Qiao Y, Kaur M, Klueh U, Kreutzer DL, Novitsky YW. Human monocyte activation by biologic and biodegradable meshes in vitro. Surg Endosc 2010; 24 (04) 805-811
    CrossrefPubMedSearch in Google Scholar
  • 20 Yu D, Hanna KR, LeGallo RD, Drake DB. Comparison of the histological characteristics of ADM capsules to no-ADM breast capsules in ADM-assisted breast reconstruction. Ann Plast Surg 2016; 76: 485-488
    CrossrefPubMedSearch in Google Scholar
  • 21 Leong M, Basu CB, Hicks MJ. Further evidence that acellular cadaveric dermis (AlloDerm®) decreases inflammatory markers of capsule formation in implant-based breast reconstruction. Plast Reconstr Surg 2013; 132: 131-132
    CrossrefPubMedSearch in Google Scholar
  • 22 Vardanian AJ, Clayton JL, Roostaeian J. , et al. Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix. Plast Reconstr Surg 2011; 128 (05) 403e-410e
    CrossrefPubMedSearch in Google Scholar
  • 23 Breuing KH, Warren SM. Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg 2005; 55 (03) 232-239
    CrossrefPubMedSearch in Google Scholar
  • 24 Zienowicz RJ, Karacaoglu E. Implant-based breast reconstruction with allograft. Plast Reconstr Surg 2007; 120 (02) 373-381
    CrossrefPubMedSearch in Google Scholar
  • 25 Sbitany H, Sandeen SN, Amalfi AN, Davenport MS, Langstein HN. Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: a head-to-head comparison of outcomes. Plast Reconstr Surg 2009; 124 (06) 1735-1740
    CrossrefPubMedSearch in Google Scholar
  • 26 Chun YS, Verma K, Rosen H. , et al. Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. Plast Reconstr Surg 2010; 125 (02) 429-436
    CrossrefPubMedSearch in Google Scholar
  • 27 Nahabedian MY. Acellular dermal matrices in primary breast reconstruction: principles, concepts, and indications. Plast Reconstr Surg 2012; 130 (05) (Suppl. 02) 44S-53S
    CrossrefPubMedSearch in Google Scholar
  • 28 Zhong T, Hu J, Bagher S. , et al. A comparison of psychological response, body image, sexuality, and quality of life between immediate and delayed autologous tissue breast reconstruction: a prospective long-term outcome study. Plast Reconstr Surg 2016; 138 (04) 772-780
    CrossrefPubMedSearch in Google Scholar
  • 29 JoAnna Nguyen T, Carey JN, Wong AK. Use of human acellular dermal matrix in implant- based breast reconstruction: evaluating the evidence. J Plast Reconstr Aesthet Surg 2011; 64 (12) 1553-1561
    CrossrefPubMedSearch in Google Scholar
  • 30 Baxter RA. Intracapsular allogenic dermal grafts for breast implant-related problems. Plast Reconstr Surg 2003; 112 (06) 1692-1696 , discussion 1697–1698
    CrossrefPubMedSearch in Google Scholar
  • 31 Haddock N, Levine J. Breast reconstruction with implants, tissue expanders and AlloDerm: predicting volume and maximizing the skin envelope in skin sparing mastectomies. Breast J 2010; 16 (01) 14-19
    CrossrefPubMedSearch in Google Scholar
  • 32 Bindingnavele V, Gaon M, Ota KS, Kulber DA, Lee D-J. Use of acellular cadaveric dermis and tissue expansion in postmastectomy breast reconstruction. J Plast Reconstr Aesthet Surg 2007; 60 (11) 1214-1218
    CrossrefPubMedSearch in Google Scholar
  • 33 Namnoum JD. Expander/implant reconstruction with AlloDerm: recent experience. Plast Reconstr Surg 2009; 124 (02) 387-394
    CrossrefPubMedSearch in Google Scholar
  • 34 Topol BM, Dalton EF, Ponn T, Campbell CJ. Immediate single-stage breast reconstruction using implants and human acellular dermal tissue matrix with adjustment of the lower pole of the breast to reduce unwanted lift. Ann Plast Surg 2008; 61 (05) 494-499
    CrossrefPubMedSearch in Google Scholar
  • 35 Nahabedian MY. AlloDerm performance in the setting of prosthetic breast surgery, infection, and irradiation. Plast Reconstr Surg 2009; 124 (06) 1743-1753
    CrossrefPubMedSearch in Google Scholar
  • 36 Breuing KH, Colwell AS. Immediate breast tissue expander-implant reconstruction with inferolateral AlloDerm hammock and postoperative radiation: a preliminary report. Eplasty 2009; 9: e16
    PubMedSearch in Google Scholar
  • 37 Preminger BA, McCarthy CM, Hu QY, Mehrara BJ, Disa JJ. The influence of AlloDerm on expander dynamics and complications in the setting of immediate tissue expander/implant reconstruction: a matched-cohort study. Ann Plast Surg 2008; 60 (05) 510-513
    CrossrefPubMedSearch in Google Scholar
  • 38 Spear SL. Discussion. Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: a head-to-head comparison of outcomes. Plast Reconstr Surg 2009; 124 (06) 1741-1742
    CrossrefPubMedSearch in Google Scholar
  • 39 Davila AA, Seth AK, Wang E. , et al. Human acellular dermis versus submuscular tissue expander breast reconstruction: a multivariate analysis of short-term complications. Arch Plast Surg 2013; 40 (01) 19-27
    Thieme ConnectPubMedSearch in Google Scholar
  • 40 Zhao X, Wu X, Dong J, Liu Y, Zheng L, Zhang L. A meta-analysis of postoperative complications of tissue expander/implant breast reconstruction using acellular dermal matrix. Aesthetic Plast Surg 2015; 39 (06) 892-901
    CrossrefPubMedSearch in Google Scholar
  • 41 Colwell AS, Damjanovic B, Zahedi B, Medford-Davis L, Hertl C, Austen Jr WG. Retrospective review of 331 consecutive immediate single-stage implant reconstructions with acellular dermal matrix: indications, complications, trends, and costs. Plast Reconstr Surg 2011; 128 (06) 1170-1178
    CrossrefPubMedSearch in Google Scholar
  • 42 Liu AS, Kao H-K, Reish RG, Hergrueter CA, May Jr JW, Guo L. Postoperative complications in prosthesis-based breast reconstruction using acellular dermal matrix. Plast Reconstr Surg 2011; 127 (05) 1755-1762
    CrossrefPubMedSearch in Google Scholar
  • 43 Selber JC, Wren JH, Garvey PB. , et al. Critical evaluation of risk factors and early complications in 564 consecutive two-stage implant-based breast reconstructions using acellular dermal matrix at a single center. Plast Reconstr Surg 2015; 136 (01) 10-20
    PubMedSearch in Google Scholar
  • 44 Kim JY, Davila AA, Persing S. , et al. A meta-analysis of human acellular dermis and submuscular tissue expander breast reconstruction. Plast Recons Surg 2012; 129 (01) 28-41
    CrossrefPubMedSearch in Google Scholar
  • 45 Lee K-T, Mun G-H. Updated evidence of acellular dermal matrix use for implant-based breast reconstruction: a meta-analysis. Ann Surg Oncol 2016; 23 (02) 600-610
    CrossrefPubMedSearch in Google Scholar
  • 46 Serrurier LC, Rayne S, Venter M, Benn CA. Direct-to-implant breast reconstruction without the use of an acellular dermal matrix is cost effective and oncologically safe. Plast Reconstr Surg 2017; 139 (04) 809-817
    CrossrefPubMedSearch in Google Scholar
  • 47 Rodriguez-Unda N, Leiva S, Cheng H-T, Seal SM, Cooney CM, Rosson GD. Low incidence of complications using polyglactin 910 (Vicryl) mesh in breast reconstruction: a systematic review. J Plast Reconstr Aesthet Surg 2015; 68 (11) 1543-1549
    CrossrefPubMedSearch in Google Scholar
  • 48 Haynes DF, Kreithen JC. Vicryl mesh in expander/implant breast reconstruction: long-term follow-up in 38 patients. Plast Reconstr Surg 2014; 134 (05) 892-899
    CrossrefPubMedSearch in Google Scholar
  • 49 Jordan SW, Khavanin N, Fine NA, Kim JYS. An algorithmic approach for selective acellular dermal matrix use in immediate two-stage breast reconstruction: indications and outcomes. Plast Reconstr Surg 2014; 134 (02) 178-188
    CrossrefPubMedSearch in Google Scholar
  • 50 McCarthy CM, Lee CN, Halvorson EG. , et al. The use of acellular dermal matrices in two-stage expander/implant reconstruction: a multicenter, blinded, randomized controlled trial. Plast Reconstr Surg 2012; 130 (05) (Suppl. 02) 57S-66S
    CrossrefPubMedSearch in Google Scholar
  • 51 Lopez J, Prifogle E, Nyame TT, Milton J, May Jr JW. The impact of conflicts of interest in plastic surgery: an analysis of acellular dermal matrix, implant-based breast reconstruction. Plast Reconstr Surg 2014; 133 (06) 1328-1334
    CrossrefPubMedSearch in Google Scholar