Acellular Dermal Matrices: To Use or Not?

  • Maurice Y. NahabedianEmail author


Nipple-sparing mastectomy and prosthetic reconstruction is a frequent option for women considering therapeutic and prophylactic mastectomy. The use of acellular dermal matrices in the setting of prosthetic breast reconstruction has facilitated the ability to achieve full coverage of the prosthetic device and provide additional tissue support. Some surgeons feel that reconstructive outcomes are improved, whereas others feel that they are not. Thus, its use is controversial for a variety of reasons that include cost, risk of adverse events, and questionable benefits. This chapter will review the indications, techniques, and outcomes associated with the use of acellular dermal matrices in the setting of nipple-sparing mastectomy and prosthetic breast reconstruction.


Nipple-sparing mastectomy Acellular dermal matrix Breast implant Tissue expander Prepectoral breast reconstruction 1-Stage reconstruction 2-Stage reconstruction Direct to implant 


  1. 1.
    Vardanian AJ, Clayton JL, Roostaeian J, et al. Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix. Plast Reconstr Surg. 2011;128:403.CrossRefGoogle Scholar
  2. 2.
    Salzberg CA, Ashikari AY, Koch RM, Thompson EC. An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). Plast Reconstr Surg. 2011;127:514.CrossRefPubMedGoogle Scholar
  3. 3.
    Colwell AS, Damjanovic B, Zahedi B, Medford-Davis L, Hertl C, Austen WG. Retrospective review of 331 consecutive immediate single-stage implant reconstructions with acellular dermal matrix: indications, complications, trends, and costs. Plast Reconstr Surg. 2011;128:1170.CrossRefPubMedGoogle Scholar
  4. 4.
    Preminger BA, McCarthy CM, Hu QY, Mehrara BJ, Disa JJ. The influence of alloderm on expander dynamics and complications in the setting of immediate tissue expander/implant reconstruction – a matched-cohort study. Plast Reconstr Surg. 2008;60:510–3.Google Scholar
  5. 5.
    Antony AK, McCarthy CM, Cordeiro PM, et al. Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions: determining the incidence and significant predictors of complications. Plast Reconstr Surg. 2010;125:1606.CrossRefPubMedGoogle Scholar
  6. 6.
    Sacchini V, Pinotti JA, Barros A, et al. Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg. 2006;203:704–14.CrossRefPubMedGoogle Scholar
  7. 7.
    Petit JY, Veronesi U, Rey P, et al. Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases. Breast Cancer Res Treat. 2009;114:97–101.CrossRefPubMedGoogle Scholar
  8. 8.
    Vlajcic Z, Stanec S, Lambasa S, Petrovechi M, Stanec Z. Nipple-areola complex preservation: predictive factors of neoplastic nipple-areola complex invasion. Ann Plast Surg. 2005;55(3):240–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Spear SL, Rottman SJ, Seiboth LA, Hannan CM. Breast reconstruction using a staged nipple-sparing mastectomy following mastopexy or reduction. Plast Reconstr Surg. 2012;129(3):572–81.CrossRefPubMedGoogle Scholar
  10. 10.
    Jensen JA, Lin JH, Kapoor N, Giuliano AE. Surgical delay of the nipple-areolar complex: a powerful technique to maximize nipple viability following nipple-sparing mastectomy. Ann Surg Oncol. 2012;19(10):3171–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Coopey SB, Tang R, Lei L, et al. Increasing eligibility for nipple-sparing mastectomy. Ann Surg Oncol. 2013;20(10):3218–22.CrossRefPubMedGoogle Scholar
  12. 12.
    Gurtner GC, Jones GE, Neligan PC, et al. Intraoperative laser angiography using the SPY system: review of the literature and recommendations for use. Ann Surg Innov Res. 2013;7(1):1.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Novitsky YW, Rosen MJ. The biology of biologics: basic science and clinical concepts. Plast Reconstr Surg. 2012;130 Suppl 2:9S.CrossRefPubMedGoogle Scholar
  14. 14.
    Connor J, McQuillan D, Sandor M, et al. Retention of structural and biological integrity in a biologic mesh supports tissue remodeling in a primate abdominal wall model. Regen Med. 2009;4(2):185–95.CrossRefPubMedGoogle Scholar
  15. 15.
    Salzberg AC. Nonexpansive immediate breast reconstruction using human acellular tissue matrix graft (AlloDerm). Ann Plast Surg. 2006;57:1–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Zienowicz RJ, Karacaoglu E. Implant-based breast reconstruction with allograft. Plast Reconstr Surg. 2007;120:373–81.CrossRefPubMedGoogle Scholar
  17. 17.
    Spear SL, Parikh PM, Reisin E, Menon NG. Acellular dermis assisted breast reconstruction. Aesth Plast Surg. 2008;32:418–25.CrossRefGoogle Scholar
  18. 18.
    Nahabedian MY, Mesbahi AN. Breast reconstruction with tissue expanders and implants. In: Nahabedian MY, editor. Cosmetic and reconstructive breast surgery. London: Elsevier; 2009. p. 1–19.CrossRefGoogle Scholar
  19. 19.
    Reitsamer R, Peintinger F. Prepectoral implant placement and complete coverage with porcine acellular dermal matrix: a new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy. J Plast Reconstr Aesthet Surg. 2015;68:162–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Orenstein S, Qiao Y, Kaur M, Klueh U, Kreutzer D, Novitsky Y. In vitro activation of human peripheral blood mononuclear cells induced by human biologic meshes. J Surg Res. 2010;158(1):10–4.CrossRefPubMedGoogle Scholar
  21. 21.
    Banyard DA, Bourgeois JM, Widgerow AD, Evans GRD. Regenerative biomaterials: a review. Plast Reconstr Surg. 2015;135:1740.CrossRefPubMedGoogle Scholar
  22. 22.
    Macarios D, Griffin L, Chatterjee A, Lee LJ, Milburn C, Nahabedian MY. A meta-analysis assessing postsurgical outcomes between aseptic and sterile AlloDerm regenerative tissue matrix. Plast Reconstr Surg Glob Open. 2015;3(6):409.CrossRefGoogle Scholar
  23. 23.
    Dubin MG, Feldman M, Ibraham HZ, et al. Allograft dermal implant (AlloDerm) in a previously irradiated field. Laryngoscope. 2000;110:934.CrossRefPubMedGoogle Scholar
  24. 24.
    Ibraham HZ, Kwiatkowski TJ, Montone KT, et al. Effects of external beam radiation on the allograft dermal implant. Otolaryngol Head Neck Surg. 2000;122:189.CrossRefGoogle Scholar
  25. 25.
    Basu CB, Leong M, Hicks MJ. Acellular cadaveric dermis decreases the inflammatory response in capsule formation in reconstructive breast surgery. Plast Reconstr Surg. 2010;126:1842.CrossRefPubMedGoogle Scholar
  26. 26.
    Prantl L, Schreml S, Fichtner-Feigl S, et al. Clinical and morphological conditions in capsular contracture formed around silicone breast implants. Plast Reconstr Surg. 2007;120:275.CrossRefPubMedGoogle Scholar
  27. 27.
    Uzunismail A, Duman A, Perk C, Findik H, Beyhan G. The effects of acellular dermal allograft (AlloDerm®) interface on silicone-related capsule formation: an experimental study. Eur J Plast Surg. 2008;31:179–85.CrossRefGoogle Scholar
  28. 28.
    Stump A, Holton LH, Connor J, Harper JR, Slezak S, Silverman RP. The use of acellular dermal matrix to prevent capsule formation around implants in a primate model. Plast Reconstr Surg. 2009;124:82.CrossRefPubMedGoogle Scholar
  29. 29.
    Komorowska-Timek E, Oberg KC, Timek TA, Gridley DS, Miles DAG. The effect of AlloDerm envelopes on periprosthetic capsule formation with and without radiation. Plast Reconstr Surg. 2009;123:807.CrossRefPubMedGoogle Scholar
  30. 30.
    Sbitany H, Sandeen SN, Amalfi AN, Davenport MS, Langstein HN. Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: a head-to-head comparison of outcomes. Plast Reconstr Surg. 2009;124:1735–40.CrossRefPubMedGoogle Scholar
  31. 31.
    Chun YS, Verma K, Rosen H. Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. Plast Reconstr Surg. 2010;125:429.CrossRefPubMedGoogle Scholar
  32. 32.
    Chen CM, Disa JJ, Sacchini V, et al. Nipple-sparing mastectomy and immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg. 2009;124(6):1772–80.CrossRefPubMedGoogle Scholar
  33. 33.
    Nahabedian MY. Mastectomy, nipple areolar preservation, and immediate implant reconstruction: are total and partial muscle coverage techniques aesthetically equivalent? Plast Reconstr Surg. 2010;126(6):319e–20.CrossRefPubMedGoogle Scholar
  34. 34.
    Reish RG, Lin A, Phillips NA, et al. Breast reconstruction outcomes after nipple-sparing mastectomy and radiation therapy. Plast Reconstr Surg. 2015;135(4):959–66.CrossRefPubMedGoogle Scholar
  35. 35.
    Ibrahim AM, Koolen PG, Ganor O, et al. Does acellular dermal matrix really improve aesthetic outcome in tissue expander/implant-based breast reconstruction? Aesthetic Plast Surg. 2015;39(3):359–68.CrossRefPubMedGoogle Scholar
  36. 36.
    Jansen LA, Macdam SA. The use of AlloDerm in postmastectomy alloplastic breast reconstruction: part II. A cost analysis. Plast Reconstr Surg. 2011;127:2245.CrossRefPubMedGoogle Scholar
  37. 37.
    De Blacam C, Momoh AO, Colakoglu S, Slavin SA, Tobias AM, Lee BT. Cost analysis of implant-based breast reconstruction with acellular dermal matrix. Ann Plast Surg. 2012;69(5):516–20.CrossRefPubMedGoogle Scholar
  38. 38.
    ASPS procedural statistics. Accessed 11 Sept 2015.Google Scholar
  39. 39.
    Krishnan NM, Chatterjee A, Rosenkranz KM, Powell SG, Nigriny JF, Vidal DC. The cost effectiveness of acellular dermal matrix in expander-implant immediate breast reconstruction. J Plast Reconstr Aesthet Surg. 2014;67(4):468–76.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Plastic SurgeryGeorgetown UniversityWashington, DCUSA

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