Implant-based breast reconstruction with allograft

Background: Reconstructive breast surgeons often prefer autologous tissue for those patients who can tolerate it. However, reconstruction with implants is technically easier, quicker, less traumatic, and less costly. Nevertheless, inherent problems associated with implants present some limitations to their use in reconstruction. In this study, a multipurpose application of allogenic dermal grafts to solve the problems seen in immediate breast reconstruction with implants was examined. Methods: After skin-sparing mastectomy, a subpectoral pocket is created for the implant. After the origins of the pectoralis major muscle are released, AlloDerm is sewn to the lower pole of the released muscle. Grafts are tailored according to the dimensions of the defect. AlloDerm, an allogenic dermal graft, is fixed to the pectoralis major superiorly, to the chest wall inferiorly and inferomedially, and to the serratus anterior flap laterally. A postoperative adjustable implant is placed into the pocket that has bene created. Result: Allografts were used to reconstruct 30 breasts in 24 patients immediately after skin- or nipple-sparing mastectomy. There was no complication related to simultaneous allograft application. No rippling, symmastia, or bottoming-out deformity was seen. Conclusions: Breast reconstruction with implant and AlloDerm enables the surgeon to create a submuscular pocket large enough to place a fully inflated breast implant. Interposition of a lower-pole internal sling, to increase the capacity of the pectoralis major pocket while providing immediate ability to achieve full or subtotal prosthetic fill and optimal aesthetic breast contouring and to maintain thicker muscle coverage in the upper and medial pole areas and stronger lower pole support, would obviate many of the current disadvantages to implant reconstruction.