How is placement of acellular dermis performed in breast reconstruction?

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

The pectoralis major is first disinserted at the inferior origin along the inframammary fold, then separated from the rectus and serratus fascia (see the first image below). A thick 6 × 16 cm piece of acellular dermis is sutured to the ensuing inferior defect in the pectoralis major (see the second image below).

Disinsertion of lower border of pectoralis major w Disinsertion of lower border of pectoralis major with Bovie electrocautery.
Intraoperative placement of acellular dermal matri Intraoperative placement of acellular dermal matrix (ADM). Inferiorly, ADM is secured to chest wall to recreate inframammary fold.

The lateral aspect of the ADM is then secured to the serratus fascia in a similar fashion. The supralateral aspect of the cavity is secured by attaching the lateral border of the pectoralis major to the serratus (see the image below). Care must be taken in suturing the ADM to the fascia and muscle: folds or inversions of the ADM can create granulomas. [12, 28] Additionally, placement of the ADM should be arranged as to maintain or recreate the inframammary fold. A tissue expander or implant is then placed in the submuscular and subgraft space and secured.

Laterally, acellular dermal matrix (ADM) is direct Laterally, acellular dermal matrix (ADM) is directly secured to serratus to create lateral portion of mammary fold. Disinserted pectoralis major is secured inferiorly to ADM and laterally to serratus to provide complete coverage of tissue expander or implant.

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