Expander/Implant Reconstruction with AlloDerm: Recent Experience

Background: 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. Methods: 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. Results: 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. Conclusions: 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. ( Plast. Reconstr. Surg. 124: 387, 2009.)