Human Acellular Dermis Breast Reconstruction,
When it comes to breast reconstruction over the last decade, the use of acellular dermal matrices in conjunction with subpectoral tissue expander placement has become commmonplace. Some of the advantages that the use of acellular dermal matrices allow, are:
1) higher initial expander fill volumes.
2) better definition of the newly constructed inframammary fold.
3) less visible rippling of the lower pole of the final breast implant.
However, a recent study evaluated some of the risks that are also associated with
Breast reconstruction with Acellular Dermal Matrix (ADM), (Parks et al. Human Acellular Dermis versus No Acellular Dermis in Tissue Expansion Breast Reconstruction. Plast Reconstr Surgery J. Vol 130, No 4, October 2012, p739).
The Study Findings:
1) The presence of seroma, skin necrosis, and exposure to radiation increased the risk of tissue expander loss.
2) The presence of acellular dermis did not increase the incidence of tissue expander loss
3) The presence of acellular dermis was associated with a doubling in the frequency of seroma formation (30% compared with 15.7% in the no acellular dermis cohort).
This study is very important in terms of understanding both the advantages and disadvantages that certain operations may have. In terms of acellular dermal matrix use, seroma formation can indeed be a problem. I routinely use closed suction drains (Jackson-Pratt type) in an effort to evacuate any inflammatory fluid that can accumulate during these types of procedures.