Breast cancer sucks. I love to do reconstruction. I think the true goal of reconstruction is so you can forget. You get up, get dressed, go through your whole day and you don’t think “I am a breast cancer patient.”
Tissue expander and implant reconstruction is the most common reconstruction done. A big issue, particularly for my ultra thin Bay Area women, is poor coverage over the implant. These women are thin: they have no fat, thin skin, and no breast tissue after mastectomy. Many won’t expand well in the lower portion of the breast, which is where we’d love to see you expand more to get a natural breast look.
Along came acellular dermal matrix. What is that in English? It is dermis, essentially an extra layer of skin. It is great to help “thicken” tissue which is too thin, help implant position, and give better coverage over the implant. It has become more popular in the past few years, and has helped some patients avoid a larger surgery involving muscle flaps.
Is it better?
A recent study came out in PRS (our big plastic surgery journal) in Feb 2010 looking at 415 immediate breast reconstructions. They compared those which used the acellular dermal matrix versus those which did not. The study wished to assess the “risk of postoperative complications associated with the use of acellular dermal matrix assisted implant based reconstruction.” The two patient groups were matched for age, cormorbidities, smoking, radiation, cancer stage.
Findings?
Acellular dermal matrix was statistically significant risk factor for developing postoperative seroma and for infection. There was a 4x seroma rate, and 5 x the infection rate.
There are many variables, as with all things. This study should be taken with a grain of salt. But I think their final thought is a good one: “The selection criteria for acellular dermal matrix utilization in breast reconstruction should be more carefully determined by critically assessing the potential benefits.” “Routine use of acellular dermal matrix in every implant based breast reconstruction seems unwarranted.”
I agree.