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 Dr. Salzberg |
AlloDerm is a versatile regenerative tissue matrix that covers and replaces lost tissues while providing structural support. It can be used anywhere in the body for reconstructive purposes, such as in abdominal hernia repair and breast reconstruction, and also in the aesthetic arena for additional support of breast implants or for the correction of deformities after suboptimal outcomes in breast augmentation surgeries.
"AlloDerm has been very useful in the correction and prevention of many of the typical adverse events seen in breast augmentation surgery, such as rippling, wrinkling and implant malposition, which have been challenging to correct in the past. Where tissues may be lax and skin thin, AlloDerm can give much-needed support and volume and hold the implant in position," says C. Andrew Salzberg, M.D., associate professor of plastic surgery, New York Medical College, and chief of plastic surgery, Westchester Medical Center, Valhalla, N.Y., which was the first center to use tissue matrix in the breast in 2001.
ALLODERM'S ORIGINS The unique tissue matrix produced by LifeCell comes from donated skin that undergoes a processing technique to remove the epidermis and cells, resulting in an extracellular matrix that serves as an ideal construct for rapid revascularization, white cell migration and host cell repopulation. LifeCell has a human acellular dermal matrix (HADM) and a porcine acellular dermal matrix (PADM) variant, the latter known as Strattice (LifeCell)."The HADM and PADM can both be used for reconstructive and aesthetic indications without any concern of host rejection. However, PADM is more commonly used for aesthetic indications for ethical reasons," Dr. Salzberg says.
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 A 36-year-old patient with BRCA 1–positive genetic status who underwent bilateral total nipple areolar mastectomy with inframammary incision, and immediate reconstruction with direct to implant acellular dermis AlloDerm regenerative tissue matrix. The patient is shown preoperatively (top) and four weeks postop. (Photos credit: Charles Andrew Salzberg, M.D.) |
"We use the same incisions in patients who have had previous breast augmentation surgery. Typically, we open the incision, modify the pocket for the implant and then suture the material in, and then hold it in a position to maintain the newly created pocket," Dr. Salzberg says.
The categories for implant malposition are inferior, lateral or medial, and the goal of the corrective procedure is to bring the breast into a more aesthetic position. AlloDerm can be useful in reshaping and holding the pocket where it is placed, creating a lower pole that results in a more rounded fullness and a natural-looking breast.
Rippling or wrinkling are stretch deformities seen as skin striations that are not uncommon following breast augmentation surgery. This typically occurs in patients with thin skin and/or when the breast has fallen too caudally and stretches the skin.
"AlloDerm can provide an extra layer of coverage between the implant and the skin and offers the required support for the implant, so that it doesn't wrinkle and ripple, but instead remains smooth and round," Dr. Salzberg says.
