Post operative photos of a patient who has undertaken a Right skin sparing mastectomy and immediate reconstruction of the breast using an acellular dermal matrix and implant, as well as having a left breast enhancement at the same operation July 2015

Using Acellular Dermal Matrix for Immediate Breast Reconstruction

Immediate breast reconstruction with implants or tissue expanders is a common surgical technique. However, achieving coverage of the implant/expander to ensure the implant is held in place in the mastectomy pocket is a key technical challenge.

 

Most patients require a “two stage” procedure involving an initial operation to place a temporary expanding implant followed by inflation or expansion of the salt water (saline) filled implant. A second operation is then performed to change the fully expanded implant to a gel filled shaped implant which is permanent.

 

Acellular Dermal Matrix (ADM) offers a solution to this challenge as a tissue substitute to allow a gel implant to be placed at the first operation and to avoid a second operation to change the expander implant. The aim of using an ADM is to provide a cover or “internal bra” to allow a definitive implant to be placed immediately and therefore the mastectomy and complete reconstruction can be performed at one operation instead of two.

 

What is an ADM?

 

The ADM we currently use is called Surgimend. This is derived from fetal bovine dermis (skin) that is used to supplement the pectoralis major muscle deficiencies at the breast lower pole.

 

The pectoralis major muscle deficit encountered inferiorly in expander reconstructions is supplemented by the Surgimend ADM, thereby providing coverage and support at the breast lower pole. In this technique, complete coverage of the expander at the breast lower pole is attained with one piece of Surgimend ADM. This allows a breast implant to be placed immediately,

rather than an expander, saving the patient many outpatient visits for expansion and a second operation to exchange the expander for the implant.

 

What are the risks of the operation?

 

Since the introduction of ADM reconstruction there has been guidance issued by the Association of Breast Surgeons (ABS) and the British Association of Plastic and Aesthetic Surgeons (BAPRAS) regarding the resources needed and the usage of ADM in breast reconstruction. Patient selection is the most

important aspect of this as well as a reliable mastectomy technique, the use of drains and the use of antibiotics to cover the operation.

 

The specific complication rates are listed below and are current figures based on Mr Davies specific practice data:

 

General complication rate of all breast surgery

 

Wound infection <5%

Return to theatre the same evening for post op bleeding 1.4%

Implant removal due to infection 1.5%

 

Current Complication Rate related to ADM reconstruction is 0%