Using ADM and her advanced surgical techniques, Dr. Cassileth corrects the most common complications of breast implant surgery that were once considered impossible to fix.
Acellular Dermal Matrix eventually gets integrated into the body and is completely replaced by the patient’s own collagen resulting in a thicker, stronger layer of tissue than the one that would have developed in the absence of the ADM. It is natural and bioresorbable yet maintains its strength over time. ADM is attached with absorbable sutures to the existing capsule, anchoring it to its new position.
View the different procedures below to see how Dr. Cassileth uses Acellular Dermal Matrix.
Acellular dermal matrix is made from the collagen layer of human skin. Collagen is what gives skin its strength and flexibility. It comes from a human tissue bank, the same kind of banks which give us cornea transplants and tendon transplants for orthopedic surgery.
Dr. Cassileth often uses Acellular Dermal Matrix in breast implant revision surgeries because the implant position often needs to be corrected. Sometimes the implants can be too low, too lateral, or too close together and too close to the center. Dr. Cassileth creates a bra-like support with ADM to control the breast shape, and the position of the implants.
Patients sometimes present with loose, large capsules which cause the implants to move too far out to the side. In cases such as these, the doctor discovers either a pocket that was over-dissected at the initial surgery or the patient formed a naturally loose, stretchy capsule. In both scenarios, the implants now sit too low, over to the side, and too far apart. The ADM is used to redefine the space in which the implant is allowed to move by suturing the ADM to the capsule. It essentially creates a new, tighter pocket for the implant that secures it in the correct position.
“Breadloafing” refers to implants that are too close together and occurs when the implants either sit in pockets that are too close together or they sit in one open cavity instead of having two separate pockets. With breadloafing the breasts need to be separated into two healthy separate areas, just like normal breasts. In this case the ADM is attached to the capsule, and then sutured down to create a new barrier for the implant at the center of the chest. The implant can no longer cross over the sternum.
Capsular contracture is a condition that results in breasts that are hard, distorted and sometimes even painful. There are several theories as to why capsular contracture develops. One of the most commonly accepted theories is that during the initial surgery, bacteria were introduced into the implant pocket. The body reacts to the bacteria with inflammation and laying down collagen fibers that continue to tighten over time.
Imagine the capsule as a net, with all the fibers contracting and tightening at the same time. Eventually, the net gets so much smaller that it is the same size as the implant. At that point, the implant can no longer move within the net, so it becomes hard and immobile.
In order to stop the tightening of the collagen net around the implant, we must surgically control the space, or interface, between the breast and the implant.
This interface is acellular dermal matrix (ADM). It is a thick sheet of collagen that comes from the dermal layer of the skin. During the procedure to correct capsular contracture the original implant and the capsule are removed. Next, The ADM is sewn to the bottom edge of the pectoralis muscle and along the bottom of the breast at the inframammary fold, creating a protective pocket for the implant. The placement of the ADM in this manner redirects the way collagen is laid down so the capsule cannot tighten around the implant.
Finally, a drain is placed, and the surgical field is closed. The drain is necessary to avoid developing fluid around the new implant and ADM, because collected fluids may harbor bacteria. Oral antibiotics are prescribed.
One of the challenges in breast reconstruction is ensuring that the implant is placed in the correct location; if they are too high, too low, too close together or too far apart, they will not look right. Acellular Dermal Matrix enables Dr. Cassileth to create a perfectly tailored pocket and affix the pocket in the right spot so that the implants rest exactly where they should.
ADM also gives the reconstructed breast flexibility. It is much softer and much less likely to develop a capsular contracture.
Most importantly, it allows the implant to be placed in one stage right after skin-sparing mastectomy. We no longer need to use expanders to create a pocket, since we now create a pocket that supports the implant using ADM.
Acellular Dermal Matrix cannot be felt once it's placed in the body as it is laid out in a nice smooth, even way.
The ADM acts as an empty collagen scaffold, which becomes incorporated into the body over time, and gets blood flow. It is usually fully absorbed six months after surgery.
There are many different types of acellular dermal matrix. Some of the brand names are: Strattice, BellaDerm, FlexHD, and AlloDerm.
The products are differentiated by source of the ADM tissue. Strattice is porcine, derived from pigs. The others are derived from human tissue that has been purified.
All of these products are fully approved by the Federal Drug Administration (FDA).
Learn more about how Alloderm® works in this video from LifeCell (the manufacturer):
ADM has been in use for 18 years and is proven to be very safe and effective. It is used in a variety of surgical procedures such as hernia repair, burn wounds, and soft tissue repair. It is often used in treating more dangerous, infected wounds. It is thought to be much safer than putting in a prosthetic mesh because it is natural human tissue.
Acellular Dermal Matrix is a solution to many breast problems resulting from breast implants gone wrong. For these reasons and more Dr. Cassileth has had reliable success in using acellular dermal matrix in her breast implant revision surgeries as well as in breast reconstruction. If you think that you or someone you know would benefit from fixing a prior breast augmentation with ADM, or are in need of breast reconstruction with beautiful, natural results, please give us call at 310.278.8200 to set up your consultation for breast surgery with ADM.