Tissue 'Lattice' Safely Provides Good Reconstruction Outcomes after Mastectomy

Newswise — Philadelphia, Pa. (May 29, 2012) – Biomaterials called "acellular dermal matrices" (ADMs) provide good outcomes, with low complication rates, when used for breast reconstruction after mastectomy for breast cancer, according to a study in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

A review by Drs. Scot B. Glasberg and David Light of Lenox Hill Hospital, New York, describes the use of two types of ADM materials in the initial stage of breast reconstruction—specifically, for supporting the underside of the breast. They believe that, with careful attention to technical details, ADMs can provide consistently good results in breast reconstruction. Materials Provide 'Lattice' for Tissue RegenerationDrs. Glasberg and Light report their experience with ADMs in 186 women undergoing two-stage breast reconstruction after mastectomy for breast cancer treatment (or prevention) between 2004 and 2007. In two-stage reconstruction, a tissue expander is first placed to increase the amount of the patient's own skin available for reconstruction. In the second stage, performed some months later, the reconstruction is completed using this additional skin plus breast implants.

All types of ADMs are made from skin from which the cells have been removed, leaving behind a sterile framework or "lattice" of tissue that the patient's own cells can grow into and eventually replace. Using ADMs to support the lower border of the reconstructed breast helps to avoid the difficulties and limitations of other reconstructive techniques.

The plastic surgeons reconstructed a total of 270 breasts using ADMs. At first, they used ADMs created from donated human skin (AlloDerm®). Later, an alternative product made from pig skin (Strattice™) was used. The researchers analyzed the results and complications of the ADM reconstructions.

Good Reconstructive Outcomes without Major ComplicationsThe overall complication rate was higher with AlloDerm compared to Strattice: about 21 versus 6 percent. This reflected a higher rate of seromas with AlloDerm. Seromas are collections of wound fluid (serum) occurring after surgery, and are generally easily managed by draining the excess fluid buildup.

Other complications were similar between groups, and there was no difference in serious complications. With both types of ADM, there was a about a two percent rate of mild capsular contracture—hardening of the tissues around the implant—compared to a 10 to 20 percent rate for reconstruction techniques not using ADMs.

Follow-up evaluations showed good final results with both types of ADMs. After implantation, both materials were well integrated into the woman's own tissues—the "lattice" was repopulated with the patient's own cells and a good blood supply.

There was some evidence of tissue warmth and redness after surgery. While previous reports have suggested this indicates inflammation or infection, the authors suggest it may be due to "cellular repopulation" of the ADM.

Originally developed as an alternative to skin grafting in burn patients, ADMs have found roles in other types of reconstructive surgery as well. Their use to "reinforce" the lower border of the reconstructed breast helps to avoid some of the potential limitations and disadvantages of other reconstructive techniques are mastectomy.

The experience supports the use of ADMs in two-stage breast reconstruction, Drs. Glasberg and Light believe. The good outcomes, in addition to low risk of serious complications, "justifies the cost associated with the use of ADMs in breast reconstruction," the researchers write. They share some important tips for other plastic surgeons to follow in achieving consistently good outcomes and low complication rates with ADMs for breast reconstruction.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

# # #About Plastic and Reconstructive SurgeryFor more than 60 years, Plastic and Reconstructive Surgery® (http://journals.lww.com/plasreconsurg/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPSThe American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. For more information, please visit www.plasticsurgery.org.

About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

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Plastic and Reconstructive Surgery