What is included in patient education about breast reconstruction with acellular dermis?

Updated: Jul 29, 2021
  • Author: John Y S Kim, MD, FACS; Chief Editor: James Neal Long, MD, FACS  more...
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Answer

Answer

Patients should be informed of the screening processes for using acellular dermal matrix (ADM) so that they can better understand the minimal possibility of disease transmission. Generally, patients with moderate-sized to large breasts benefit most from the use of acellular dermis because release of the pectoralis allows better use of the excess skin. However, the ultimate decision whether to use acellular dermis should be made intraoperatively.

Well-vascularized mastectomy flaps are needed to avoid mastectomy flap necrosis. Lanier et al reported that patients with larger breasts had a higher overall complication rate than those with smaller breasts, although the differences did not reach statistical significance. [18] They hypothesized that larger mastectomy flaps are potentially at higher risk for ischemia, which can lead to delayed incorporation of acellular dermis and thus to increased complication rates. [18]

In addition, patients who may be undergoing postoperative radiation therapy, which can lead to complications, should be given the option to choose delayed autogenous reconstruction with a latissimus dorsi myocutaneous flap or reconstruction with a transverse rectus abdominis muscle (TRAM) flap. However, some studies have reported favorable outcomes and reduced complications with the acellular dermis technique in the setting of postoperative irradiation. [11, 27]


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