When it comes to breast reconstruction, there are many options for patients and their surgeons to consider. For instance, breast reconstruction technique will often depend on the type of mastectomy (or other breast procedure) that was performed in order to adequately remove the initial breast cancer. Some women choose to have no breast reconstruction at all. However, for those that do they must decide (in conjunction with their plastic surgeon) which options suits them best: tissue-expander/implant-based reoconstruction, pedicled latissimus dorsi muscle flap reconstruction, pedicled TRAM flap reconstruction, free flap reconstruction, etc. Further, in recent years there have been two growing trends that have changed the manner in which breast reconstruction occurs. The first increasing trend has been seen in performance of skin and nipple-sparing mastectomy procedures. This is particularly true for the growing number of prophylactic mastectomy for BRCA gene positive family members of cancer patients. The second increasing trend has been seen with respect to the use of acellular dermal matrices and other regenerative matrix products. These graft materials have become very helpful during breast reconstruction procedures (and breast revision surgery) since they allow coverage of the lower pole of the breast implant or tissue expander, where there is an anatomic deficiency of native muscle coverage. Further, when sewn in and placed properly, they help to reduce tension on the mastectomy flaps that can be created by the sheer weight and mass of the breast implant device.
A new study has reviewed one institutions experience with use of Acellular Dermal Matrix (i.e. Alloderm) in patients undergoing immediate single stage, direct to implant breast reconstruction(Colwell, et al. Plas Recon Surg, Vol 128, No 6, p1170, Dec 2011). The authors reviewed the charts of 211 patients who collectively underwent 331 direct to implant reconstruction procedures using Alloderm (one-stage reconstruction) following nipple-sparing or skin-sparing mastectomies for cancer (216) or breast cancer prophylaxis (115). They reviewed the total number of complications which included 10 infections (3%), five seromas (1.5%), four hematomas (1.2%) and 30 cases (9.1%) of skin necrosis (loss) which resulted in five implant losses (1.5%). They compared these statistics to 158 similar reconstruction for patients who underwent tissue expander reconstruction (two-stage reconstruction) without the use of Alloderm. They had similar complication rates which included: nine infections (5.7%), three seromas (1.9%), three hematomas (1.9%) and 16 reconstructions (10.1%) with skin necrosis leading to 11 implant losses (7.0%). In their experience over the three year study period, the total number of complications did decrease in each subsequent year as total experience increased. Further, there was also noted to be a higher complication rate in both groups for patients that required external beam irradiation.
*photos on this post are not actual patients of Dr. Brenner.