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Richard E. Baxter - Acellular Dermal Matrices in Breast Surgery, an Issue of Clinics in Plastic Surgery

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Acellular Dermal Matrices in Breast Surgery, an Issue of Clinics in Plastic Surgery: summary, description and annotation

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Topics include: Defining the problem/proof of concept; The reconstructive model; Do ADMs change the rationale for immediate vs. delayed?; Direct to implant reconstruction; Capsular contracture and ADMs; Pocket reinforcement/bottoming out; ADMs in the irradiated breast; Emerging applications; Comparison of different ADM materials; Tips and pearls; Economic considerations

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Clinics in Plastic Surgery, Vol. 39, No. 2, April 2012

ISSN: 0094-1298

doi: 10.1016/S0094-1298(12)00016-8

Contributors List

Clinics in Plastic Surgery

Acellular Dermal Matrices in Breast Surgery

Richard A. Baxter MD

Plastic Surgery Clinic, 6100 219th Street SW, Suite 290, Mountlake Terrace, WA 98043, USA

ISSN 0094-1298

Volume 39 Number 2 April 2012

Contents

Clinics in Plastic Surgery, Vol. 39, No. 2, April 2012

ISSN: 0094-1298

doi: 10.1016/S0094-1298(12)00018-1

Forthcoming Issues

Clinics in Plastic Surgery, Vol. 39, No. 2, April 2012

ISSN: 0094-1298

doi: 10.1016/j.cps.2012.02.008

Current State of the Art for Acellular Dermal Matrices in Breast Surgery

Richard A. Baxter, MD


Plastic Surgery Clinic, 6100 219th Street SW, Suite 290, Mountlake Terrace, WA 98043, USA

E-mail address: drbaxter@drbaxter.com

Richard A Baxter MD Guest Editor The use of acellular dermal matrices - photo 1Richard A. Baxter, MD, Guest Editor

The use of acellular dermal matrices (ADMs) in breast surgery has been transformative over the past decade. For implant-related problems, they can provide a unifying solution to the multiple issues stemming from inadequate tissue for coverage and support. The concept of a living internal bra is a compelling one for patients and plastic surgeons alike. Challenging problems such as implant rippling, malposition, and capsular contracture have all found a potential solution with ADMs. Extending this concept to reconstruction, ADMs have helped define a new model. Along with increasing use of skin- and nipple-sparing mastectomy, the availability of BRCA genetic testing, and better implants, many patients now achieve superior outcomes with mastectomy than with breast-conserving treatment with radiation and lumpectomy. Many thoughtful innovators have contributed to these developments, and this issue of the Clinics in Plastic Surgery is dedicated to those forward-thinking surgeons.

Controversies remain and so I have encouraged the contributors to this issue to take a balanced view. Indications for use are not rigorously defined for every potential application despite the utility demonstrated by broad clinical experience, and prospective trial data where they exist often lack clearly delineated inclusion/exclusion criteria. This issue addresses the current state of the art with ADMs in breast surgery and I hope will provide some guidance as the science evolves.

Clinics in Plastic Surgery, Vol. 39, No. 2, April 2012

ISSN: 0094-1298

doi: 10.1016/j.cps.2011.09.007

Erratum

Skin Tissue EngineeringIn Vivo and In Vitro Applications CPS Volume 39, Issue 1, Pages 1-102 (January 2012)

Florian Groeber a,b,1, Monika Holeiterac,1, Martina Hampela,b, Svenja Hinderera,c, Katja Schenke-Laylanda,c,*

a Department of Cell and Tissue Engineering, Fraunhofer-Institute for Interfacial Engineering and Biotechnology (IGB), Nobelstrasse 12, 70569 Stuttgart, Germany

b Institute for Interfacial Engineering, Nobelstrasse 12, 70569 Stuttgart, Germany

c Faculty of Medicine, Eberhard Karls University Tbingen, Silcherstrasse 7, 72076 Tbingen, Germany

1 Both authors contributed equally to this manuscript.

* Corresponding author. Department of Cell and Tissue Engineering, Fraunhofer IGB, Nobelstrasse 12, 70569 Stuttgart, Germany.

This article is a re-publication of an article previously published in Advanced Drug Delivery Reviews, Volume 63, Issues 45, Pages 193-404 (30 April 2011); doi:10.1016/j.addr.2011.01.005.

This re-publication was initiated by the Publisher and credited to the original journal.

The article has been withdrawn due to the accidental and unintentional assignation of a new DOI.

The Publisher regrets the inconvenience caused.

Clinics in Plastic Surgery, Vol. 39, No. 2, April 2012

ISSN: 0094-1298

doi: 10.1016/j.cps.2011.12.001

Acellular Dermal Matrices in Breast Implant Surgery: Defining the Problem and Proof of Concept


Private Practice, Seattle, WA, USA

* 6100 219th Street SW, Suite 290, Mountlake Terrace, WA 98043.

E-mail address: drbaxter@drbaxter.com

Abstract

The use of acellular dermal matrices (ADMs) has become a useful adjunct to implant-based breast reconstruction and revision of the augmented breast. In both instances, the goal is replacement or reinforcement of thinned or missing tissues for implant support and control of the implant pocket. This article reviews the factors that contribute to periprosthetic tissue thinning, and the advantages and limitations of the use of ADMs for revision breast surgery and breast reconstruction. Proof of concept for the use of ADMs in the periprosthetic space is detailed from early clinical experience and histologic analysis documenting vascular ingrowth and cellular repopulation.

Keywords

Acellular dermal matrix Revision breast augmentation Breast reconstruction Implant capsule

Key Points

1. Acellular dermal matrices (ADMs) have been used for more than 10 years for revision breast surgery and primary reconstructive and aesthetic breast surgery.
2. ADMs may act as a template for tissue regeneration via vascular ingrowth, cellular repopulation, and tissue remodeling.
3. ADMs in revision breast surgery address problems stemming from periprosthetic tissue thinning such as implant malposition and visible rippling.
4. Implant-based postmastectomy reconstruction may be more stable and secure with the use of ADMs.
5. Breast implantrelated problems often occur in combination.
6. More predictable and stable outcomes for revision breast implant surgery may be achieved with the use of ADMs in some circumstances.
Overview of breast augmentation and breast reconstruction

This suggests that the characteristics of the breast, and not simply the presence of a breast mound, are important; a breast hardened by radiation treatment may not necessarily be a preferable option to a reconstructed breast, provided that the reconstruction can be done with minimal morbidity and aesthetically pleasing results. Trends in recent years toward early reconstruction with implants supported by ADMs indicate that a shift in approaches to breast cancer treatment is underway.

and breast reconstruction moving up to the top 5 for reconstructive procedures. Concerns about complications focused initially on the implants and led to improved design such as the use of a barrier layer to minimize gel bleed, more cohesive silicone gels, and greater variety of profiles for better matching of implant dimensions to each patients anatomy. These improvements led to a more favorable attitude about breast implant safety.

Revision often begets further revisions, pointing to the challenges of reoperative breast implant surgery and highlighting the inadequacy of traditional approaches. Although some would argue that problems of capsular contracture, implant malposition, visible rippling, animation deformity, and other issues are largely avoidable with proper technique and implant selection, the need for solutions to these problems remains. Given that changes in tissue-implant relationships can occur over a period of years, the need for revision surgery is unlikely to be reducible beyond a minimum that is yet to be determined.

suggested a range of other possible uses. The concept of stable tissue support and/or enhancement could be extrapolated to applications in breast implant surgery.

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