Expander/Implant Reconstruction with AlloDerm: Recent Experience

Abstract

Expander/implant reconstruction with acellular dermal matrix (AlloDerm) has become an increasingly popular technique. Potential advantages include lengthening of the pectoralis major muscle, preventing "window-shading" after muscle release; precise control of the inframammary fold and lateral breast border; and complete coverage of the device without resorting to additional muscle or fascial elevation. Patients undergoing immediate breast reconstruction with tissue expanders underwent acellular dermal matrix augmentation of the pectoralis major muscle. After inferior pectoralis muscle release and creation of a subpectoral pocket, the acellular dermal matrix was draped out to length and sutured to the inframammary fold. An integral port, low-height tissue expander was placed into the pocket and the acellular dermal matrix was sewn to the cut edge of the muscle inferiorly. Subsequent placement of either a smooth-walled silicone gel implant or anatomically shaped cohesive gel device was performed secondarily. Twenty consecutive patients (29 breasts) undergoing immediate breast reconstruction with tissue expanders had acellular dermal matrix augmentation of the pectoralis major muscle. Follow-up averaged 21 months (range, 3 to 32 months). Infection occurred in one of 29 breasts (3.4 percent). One patient had a small area of suture line necrosis requiring revision. Acellular dermal matrix augmentation of the pectoralis major muscle in the setting of prosthetic breast reconstruction improves the soft-tissue drapery around devices without resorting to additional muscle or fascial flaps. Total device coverage and precise control of the pocket dimensions permit more predictably superior results in these patients.