Summary
Background
Many surgeons now incorporate Acellular Dermal Matrix (ADM) into expander-based breast
reconstruction. ADM is safe, provides full expander coverage, eliminates the need
for additional muscular dissection and has improved aesthetic outcomes. However, its
use increases surgical costs. Whether this cost is offset by decreased operative times
or a reduced number of revision procedures is unknown.
Methods
We have developed a new technique that minimises the amount of ADM required in many
patients. The ‘partial sling’ approach has been used for 145 consecutive patients
(197 breasts) by a single surgeon from 2007 to 2010. After mastectomy, any portion
of the pectoralis major insertion at, or <1 cm from, the planned inframmary fold is
left intact and becomes the inferior margin of the expander pocket. The minimal size
of ADM required is then determined by measuring from the pectoralis to the lateral
breast margin. In this study, we exclusively used AlloDerm™. Preoperative breast measurements,
intra-operative fill volume, time to exchange procedure, number of expansion procedures
and complications were recorded for all patients.
Results
Patients were grouped according to the surface area (cm2) of ADM required. Good aesthetic outcomes were obtained in all groups. Two groups
had a significant difference in intra-operative fill volumes but this did not correlate
to an increase in the number of expansion procedures required. Of 197 reconstructed
breasts less than 64 cm2 of ADM was used for 40 breasts (20%).
Conclusions
The partial AlloDerm™ sling can minimise the costs associated with ADM use in breast
reconstruction for many patients without increasing complications or altering aesthetic
outcomes.
Keywords
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Article info
Publication history
Published online: March 14, 2012
Accepted:
February 4,
2012
Received:
May 3,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
