Sumner A Slavin1, Samuel J Lin. 1. Boston, Mass. From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.
Abstract
BACKGROUND: The use of acellular dermal matrices in breast surgery has become popular in the last two decades, with a corresponding increase in experience and literature. The authors reviewed the literature and summarize key technical points regarding use of acellular dermal matrices in reconstructive breast surgery. METHODS: Current applications have emphasized both primary and secondary breast reconstruction. Newer approaches focus on breast revisional surgery, especially when matrix material is used to correct deformities commonly arising after breast implant placement. In these situations, matrices have widened the indications and improved results by providing additional support to the lower pole, extending the pectoralis major muscle, and smoothing surface irregularities. Increased use of these products has also spurred our understanding of their biological properties of cell infiltration, tolerance, and inflammation. RESULTS: Acquired deformities, such as symmastia, rippling, malposition, and lower pole bottoming out, that were previously difficult to treat are significantly improved by placement of acellular dermal matrix in the affected area. Although most of the available studies demonstrate short-term results (1 to 2 years of follow-up), our technical ability to treat complications after breast augmentation and mastopexy has expanded. Use of onlay grafts of matrix in areas of capsulectomy and capsulorrhaphy, placement of grafts of varying thickness for thinned tissues, and the wide variety of shapes and sizes of product available are reducing unfavorable aesthetic results. CONCLUSIONS: Increased complications, including seroma formation, infection, wound dehiscence, and implant exposure, remain challenging problems. Long-term studies will be needed to prove the durability of acellular dermal matrices in breast revisional surgery.
BACKGROUND: The use of acellular dermal matrices in breast surgery has become popular in the last two decades, with a corresponding increase in experience and literature. The authors reviewed the literature and summarize key technical points regarding use of acellular dermal matrices in reconstructive breast surgery. METHODS: Current applications have emphasized both primary and secondary breast reconstruction. Newer approaches focus on breast revisional surgery, especially when matrix material is used to correct deformities commonly arising after breast implant placement. In these situations, matrices have widened the indications and improved results by providing additional support to the lower pole, extending the pectoralis major muscle, and smoothing surface irregularities. Increased use of these products has also spurred our understanding of their biological properties of cell infiltration, tolerance, and inflammation. RESULTS: Acquired deformities, such as symmastia, rippling, malposition, and lower pole bottoming out, that were previously difficult to treat are significantly improved by placement of acellular dermal matrix in the affected area. Although most of the available studies demonstrate short-term results (1 to 2 years of follow-up), our technical ability to treat complications after breast augmentation and mastopexy has expanded. Use of onlay grafts of matrix in areas of capsulectomy and capsulorrhaphy, placement of grafts of varying thickness for thinned tissues, and the wide variety of shapes and sizes of product available are reducing unfavorable aesthetic results. CONCLUSIONS: Increased complications, including seroma formation, infection, wound dehiscence, and implant exposure, remain challenging problems. Long-term studies will be needed to prove the durability of acellular dermal matrices in breast revisional surgery.