What is breast reconstruction with acellular dermis?

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


With increasing frequency, surgeons are electing to use acellular dermis to assist with tissue expander– or implant-based primary breast reconstruction. [1, 2] In 2018, of the 101,657 breast reconstructions performed in the United States, 69,921 (69%) used a tissue expander and implant, and 61,713 (61%) employed acellular dermal matrix (ADM). [3] Several authors have reported favorable results for procedures involving acellular dermis, and rapid early expansion has led to improved cosmetic outcomes. [1, 4, 5, 6]

ADM has been used as a soft tissue replacement since its introduction in 1994. [7] ADMs are soft tissue matrix grafts created by a process that results in decellularization but leaves the extracellular matrix intact. This matrix provides a scaffold upon and within which the patient’s own cells can repopulate and revascularize the implanted tissue. Its utility has been demonstrated in various reconstructive techniques, particularly in burn, abdominal wall, and breast reconstruction. [7, 8, 9]

Currently, several ADMs are available for use by reconstructive surgeons, including human-derived, fully hydrated FlexHD® (Ethicon, Somerville, NJ) and BellaDerm® (MTF Biologics, Edison, NJ); human-derived, freeze-dried AlloDerm® (LifeCell, Branchburg, NJ; also available hydrated), AlloMax™ (Bard, Warwick, RI), and DermaMatrix™ (Synthes, West Chester, PA); and porcine-derived Permacol™ (Covidien, Boulder, CO) and Strattice® (LifeCell).

The introduction of ADM has provided surgeons with alternative means of obtaining sufficient vascularized soft tissue to cover the implant, thereby alleviating some complications. Breuing first reported the use of human acellular dermis in implant-based breast reconstruction in 2005. [4] Not long after, Bindingnavele reported acellular dermis–assisted tissue expander–based reconstruction. [6]

Several authors, including Salzberg [5] and Spear, [1] reported outcomes in the following years, citing increased fill volumes and improved aesthetic outcomes. In 2008, Preminger reported the first comparative study that analyzed intraoperative fill volume differences between ADM and non-ADM cohorts. [10] This provided the impetus for several other comparative studies, such as the comparison of ADM technique with submuscular coverage by Sbitany et al. [2]

In 2009, Nahabedian explored the use of acellular dermis in the context of postoperative irradiation. [11] This study addressed the increasingly widespread sentiment that acellular dermis affected complication rates in patients receiving postoperative radiation therapy and led other authors, such as Rawlani et al, to explore these effects further. [12] Larger studies, such as that of Chun et al, [13] published regression analyses of several surgical factors and their influences on complication rates.

The use of acellular dermis in breast reconstruction continues to be actively explored and will most certainly evolve as new data become available. [1, 4, 5, 6]

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!