Reconstruction using a breast implant can generally be accomplished in one of two ways:
Breast implants used in reconstruction cannot generally be placed directly in the space created by the removal of breast tissue. The reason for this is that an implant placed directly below the skin will generally not produce cosmetically desirable results and has a high risk of eroding through the surgical incision or through the skin itself.
(A) The most commonly used method of implant-based breast reconstruction involves preparation of the mastectomy site with a tissue expander. (B) With this method, a second surgical procedure is required to remove the tissue expander and replace it with and a breast implant in the space created below stretched out pectoralis muscle. (C) In a relatively small number of situations, the use of a tissue matrix such as AlloDerm® may make it possible to undergo reconstruction with a breast implant in a single stage procedure that avoids tissue expansion. With these direct-to-implant surgery procedures, a pocket is created for the implant by detaching the lower edge of the pectoralis muscle from the chest and spanning the space between the edge of the detached muscle and the chest with tissue matrix. In this manner, the tissue matrix provides an added layer of tissue between the implant and the breast skin.
With the use of a tissue matrix such as Alloderm®, some women are able to avoid the tissue-expansion phase of breast reconstruction in what has been termed a “straight-to-implant” procedure. During this kind of surgery, the lower edge of the pectoralis muscle is detached from the chest and lifted up to form the upper part of a “pocket” that will eventually contain a breast implant. The upper portion of the breast implant is placed under the lifted muscle; tissue matrix is then used to span the space between the edge of the detached muscle and the chest, thereby covering the lower portion of the breast implant. The tissue matrix is attached between the muscle edge and the chest wall so that behind the muscle and the implanted tissue matrix a pocket large enough to accommodate an implant can be created without the need for tissue expansion. Typically, small- to medium-sized breasts can be reconstructed in this manner. (Keep in mind that a second surgical procedure is still typically needed for nipple reconstruction, unless nipple-sparing mastectomy has been performed.)
Direct-to-Implant reconstructions, also called “One-Step Reconstructions,” or “One-Stage Reconstructions,” almost always require the use of a tissue matrix. A tissue matrix is a substitute for your own tissue made from either human or animal tissue. Alloderm®, one of several available tissue-matrix products, is made from donated human skin using a proprietary technique.
Alloderm® and other similar products (such as Tutoplast®, DermaMatrix® and Strattice®) created from tissue bank supplies are regulated by the U.S. Food and Drug Administration (FDA) as a human tissue used for transplantation. Unfortunately, graft failure or rejection and transmission of disease are risks associated with the use of tissue-matrix products.
For women who wish to undergo restorative breast surgery without an implant, natural-tissue reconstructive procedures may be appealing.