Biomaterials called “acellular dermal matrices” (ADMs) provide good outcomes, with low complication rates, when used for breast reconstruction after mastectomy for breast cancer, according to a study in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). Two devices, AlloDerm® and Strattice™, both from KCI Medical Inc., were included in the study.
A review by ASPS Member Surgeon Scot B. Glasberg, MD and David Light, MD of Lenox Hill Hospital, New York, describes the use of two types of ADM materials in the initial stage of breast reconstruction-specifically, for supporting the underside of the breast. They believe that, with careful attention to technical details, ADMs can provide consistently good results in breast reconstruction.
Materials Provide ‘Lattice’ for Tissue Regeneration
Drs. Glasberg and Light report their experience with ADMs in 186 women undergoing two-stage breast reconstruction after mastectomy for breast cancer treatment (or prevention) between 2004 and 2007. In two-stage reconstruction, a tissue expander is first placed to increase the amount of the patient’s own skin available for reconstruction. In the second stage, performed some months later, the reconstruction is completed using this additional skin plus breast implants.
All types of ADMs are made from skin from which the cells have been removed, leaving behind a sterile framework or “lattice” of tissue that the patient’s own cells can grow into and eventually replace. Using ADMs to support the lower border of the reconstructed breast helps to avoid the difficulties and limitations of other reconstructive techniques.
The surgeons reconstructed a total of 270 breasts using ADMs. At first, they used ADMs created from donated human skin (AlloDerm®). Later, an alternative product made from pig skin (Strattice™) was used. The researchers analysed the results and complications of the ADM reconstructions.
Good Reconstructive Outcomes without Major Complications
The overall complication rate was higher with AlloDerm compared to Strattice: about 21 versus 6 percent. This reflected a higher rate of seromas with AlloDerm. Seromas are collections of wound fluid (serum) occurring after surgery, and are generally easily managed by draining the excess fluid buildup.
Other complications were similar between groups, and there was no difference in serious complications. With both types of ADM, there was a about a two percent rate of mild capsular contracture-hardening of the tissues around the implant-compared to a 10 to 20 percent rate for reconstruction techniques not using ADMs.
Follow-up evaluations showed good final results with both types of ADMs. After implantation, both materials were well integrated into the woman’s own tissues-the “lattice” was repopulated with the patient’s own cells and a good blood supply.
There was some evidence of tissue warmth and redness after surgery. While previous reports have suggested this indicates inflammation or infection, the authors suggest it may be due to “cellular repopulation” of the ADM.
Originally developed as an alternative to skin grafting in burn patients, ADMs have found roles in other types of reconstructive surgery as well. Their use to “reinforce” the lower border of the reconstructed breast helps to avoid some of the potential limitations and disadvantages of other reconstructive techniques after mastectomy.
The experience supports the use of ADMs in two-stage breast reconstruction, Drs. Glasberg and Light believe. The good outcomes, in addition to low risk of serious complications, “justifies the cost associated with the use of ADMs in breast reconstruction,” the researchers write. They share some important tips for other plastic surgeons to follow in achieving consistently good outcomes and low complication rates with ADMs for breast reconstruction.
Source: American Society of Plastic Surgeons