Acellular Dermal Matrix Breast Augmentation

The Acellular Dermal Matrix is a skin replacement that is both natural looking and responsive to the body’s needs. The resulting breast tissue will be both firm and resilient, creating an enhanced look for any woman who chooses to undergo this procedure.

Breast augmentation surgery is one of the most popular plastic surgeries in the United States, but many women are wary of the risks involved with going under the knife. One alternative that has been gaining popularity over recent years is to use an acellular dermal matrix (ADM) breast augmentation, which involves using all-natural tissue instead of synthetic implants, reducing recovery time and potential complications. The most common type of ADM used for breast augmentation is cadaveric allograft, which is made from donated human tissue that has been prepared to be used as a medical device and sanitized to decrease or eliminate any risk of disease transmission. In this guide, we shall discuss Acellular Dermal Matrix Breast Augmentation, acellular dermal matrix complications, acellular dermal matrix vs alloderm, and acellular dermal matrix capsular contracture.

The first step in getting an ADM breast augmentation is to schedule a consultation with your surgeon. During this consultation, you will discuss your goals for your breast augmentation procedure and have the opportunity to ask questions about your options and recovery time. You may also have an exam performed during this consultation in order to determine if you are a candidate for ADM breast augmentation surgery.

Acellular dermal matrices (ADMs) are human-, bovine-, or porcine-derived biotechnologically engineered tissues that have served a myriad of purposes across surgical subspecialties. Tissue processing removes the cellular antigens capable of producing an immunologic response while maintaining the structural matrix that encourages angiogenesis and tissue regeneration. The initial reported clinical use of ADMs was in the management of full-thickness burns in 1995, and they subsequently have had a number of applications within plastic and reconstructive surgery, including in abdominal hernia repair, rhinoplasty, facial soft tissue augmentation, lip augmentation (6), and oculofacial procedures .

After the first usage in the breast by the senior author in 2001, ADMs have become a cornerstone of implant-based immediate breast reconstruction over the last 2 decades. Immediate breast reconstruction became preferred to delayed reconstruction in the 1990’s due to its improved psychosocial morbidity, decreased cost, and optimal cosmetic outcomes facilitated by the advent of skin-sparing mastectomies. Prior to the use of ADMs, effective immediate prosthesis-based breast reconstruction necessitated the use of a submuscular expander with full muscle coverage to improve soft tissue coverage prior to a permanent implant placement or removal of the filling port attached to a combination device . The disadvantages of this approach include infectious complications requiring multiple operations and patient discomfort.

acellular dermal matrix complications

Acellular dermal matrix is a tissue derived from cadavers that is used in the treatment of burn scars. It has been found to be effective at reducing scarring, improving function and helping patients feel more confident about their appearance. The procedure involves placing a piece of donated skin over the burn site and then allowing it to integrate with your own tissue over time. The grafts are made up of all three layers: epidermis, dermis and subcutaneous fat layer. However there are certain complications that can occur following this procedure which we will discuss here today…

Complications in acellular dermal matrix implants can arise due to infection, implant rejection, breakage or displacement, hypertrophic scarring and patient discomfort.

Infection is one of the most common complications of ADM procedures. It may result from improper wound care or infection at another site on the body that spreads to the implant site after surgery. If you experience fever or swelling around your wound within two weeks following surgery, contact your doctor immediately as this may be an indication of infection (1).

Other possible complications include:

Infection

Acellular dermal matrix implants are a great way to treat wounds and other skin conditions, but they do come with some risks. One of the most common complications of acellular dermal matrices is infection. Infection can be caused by bacteria or fungi and may develop on your body’s own tissue, or it can be caused by poor surgical technique during implantation. If you experience any signs of infection after an ADM procedure–swelling, redness and pain around the wound site–you should contact your doctor immediately for treatment advice

Implant rejection

Rejection is the body’s natural response to a foreign object.
It can occur if an implant is not placed correctly, or if the patient’s immune system is compromised.

Breakage or displacement

Breakage or displacement can occur during the surgical procedure.
Breakage or displacement can occur after the surgical procedure.
Breakage or displacement can occur at any time.

Hypertrophic scarring

Hypertrophic scarring is a common complication of ADM implants, and it can be caused by the following:

Infection
Poor healing
Rejection of the implant (i.e., if you’ve had multiple surgeries)

Hypertrophic scars form as your body tries to heal itself after an injury or procedure. The resulting scar is thickened, raised and often painful. The good news is that hypertrophic scars can be treated with surgery or laser therapy.

Patient discomfort

Pain
Swelling
Redness
Itching and tenderness

acellular dermal matrix vs alloderm

AlloDerm RTU^® and AlloMaxTM are two acellular dermal matrices (ADMs) used in implant-based breast reconstruction. In this study, we examined whether different processing methods for the ADMs lead to a disparity in histologic, clinical, and financial outcomes after breast reconstruction. Thirty patients undergoing implant-based breast reconstruction were randomized into AlloMax or AlloDerm arms (n = 15, each). ADM was placed at the time of immediate reconstruction. Patients were evaluated for complications on postoperative days 7, 14, and 30. During implant exchange, ADM biopsies were taken and compared histologically for vascular and cellular infiltration. Patient satisfaction was evaluated using the BRECON-31 questionnaire 1 year after implant exchange.

A cost analysis was performed comparing the two ADMs. Patient demographics and complication rates were similar between the two groups (p > 0.05). Histologically, vessel density and fibroblast/inflammatory cell infiltrate were greater on the dermal side than on the implant side (p < 0.01) in both ADMs, suggesting greater vascular and cellular in-growth from the dermal side. Vessel density in the middle portion of the Allomax biopsies was significantly higher than the same site in the Alloderm biopsies (p < 0.05). The extent of fibroblast/inflammatory cell infiltration was similar in both arms (p > 0.05). The BRECON-31 satisfaction questionnaire yielded similar responses across all metrics between the two study arms. The negotiated price was slightly different when comparing the two ADMs, with no significant difference in ADM reimbursement. In this study, AlloDerm RTU and AlloMax were successfully used for implant-based breast reconstruction with comparable outcomes.

acellular dermal matrix capsular contracture

Capsular contracture is a common complication after implant-based breast reconstruction.^2,12 It can result in cosmetic deformity, pain, patient morbidity, and additional surgical procedures. Previous studies have suggested that the use of ADM is associated with a reduced rate of capsular contracture.^5,6,19 The mechanism, however, is poorly understood. Here, we demonstrate that well-known cellular mechanisms may be at play. The protective effect of the surgical treatment of open wounds with skin grafts with respect to subsequent scar contracture is well known. Skin grafts have been shown to accelerate the myofibroblast life cycle, leading to accelerated disappearance of the myofibroblasts from the wound bed.²² In addition, Brown, Garner, and Young demonstrated that the capacity of a skin graft to inhibit wound contraction is directly proportional to the amount of structurally intact dermal collagen present in the graft.²³ We believe that the same mechanism may be at play in implant-based breast surgery.

After mastectomy and tissue expander/implant insertion, the tissue in contact with the device is essentially a raw wound bed that heals by secondary intention, that is, scar/capsule formation. Capsular contracture is believed to be the clinical corollary of the intrinsic propensity of the resulting capsule to contract. Incorporation of ADM in the reconstruction, however, allows the internal breast wound to be “grafted,” thus potentially halting the unfavorable sequelae of contracture formation, analogous to skin grafting an open wound.²²

We hypothesized that the presence of acellular dermis reduces myofibroblast cellular predominance, as was shown decades ago by Rudolph²² in a study of wound healing. Indeed, by examining both the periprosthetic capsule and the ADM cellular microenvironment histologically, we found that the presence of acellular dermis resulted in a significant reduction in myofibroblast concentration in the periprosthetic tissues and thinner capsules. Importantly, we were able to demonstrate the favorable effects of ADM on myofibroblast concentration using intraindividual controls. Interestingly, we examine the posterior capsule and perhaps, there are different forces acting on the anterior versus posterior capsule that may indeed alter the niche microenvironment and the resident cells. A further study could focus on the different cellular profiles present at the different areas of capsule in an effort to better understand capsular contracture formation. In addition, it would be interesting to explore the microenvironmental changes in capsules at different phases of development, as the capsules examined in our study developed 4–6 months postplacement.

Our findings provide an explanation for the clinical observations of decreased capsular contracture formation after ADM use in implant-based breast surgery.^4,5,16,24 Despite these favorable observations, we wish to disclose limitations of the present study. These include a small sample size and the fact that we only examined myofibroblast concentration. Future studies will focus on myofibroblast activity and proliferation in a larger number of patients. Another limitation is the age of the capsule. Specimens were obtained after a mean of 5.2 months. Hence, we cannot draw any conclusions regarding the long-term developments that occur in the periprosthetic tissues.

Despite the abundance of myofibroblasts in the periprosthetic capsule specimens, we did not observe any significant difference in vascularization between ADM and periprosthetic capsule specimens. Activated fibroblasts, including myofibroblasts, are a source of potent antiangiogenic factors such as thrombospondins 1 and 2.²⁵ Although myofibroblasts are upregulated in the setting of fibrosis, fibrosis has been associated with both an increase and a decrease in angiogenesis.²⁶ This is reflected in our results where vascularization appeared more mixed in the capsule versus ADM specimens. Furthermore, the small number of patients and variable time since implant placement and ADM difference between patients may mask any time-dependent effects of fibrosis and vascularization in the setting of breast implants and ADM. The complex relationship between myofibroblasts, angiogenesis, and fibrosis remains to be explored in future studies in a larger cohort.