AlloDerm / ADM Use for Reconstruction Surgery
AlloDerm, also known as ADM or is an acellular dermal matrix, derived from donated human skin tissue. Since AlloDerm is regarded as minimally processed and not significantly changed in structure from the natural material, the FDA has classified it as banked human tissue.
AlloDerm is made from donated human skin. It is handled in much the same way as other transplantable organs. The tissue is processed to remove cells that might cause your body to reject the foreign tissue or react negatively to it. What’s left is the collagen structure (fiber-like proteins) and other proteins naturally found in skin. This structure acts as a frame for your tissue to grow into and around.
AlloDerm comes in many sizes depending on what kind of coverage you will need.
12×12cm piece of AlloDerm
After breast augmentation surgery excessive scar tissue may form around the breast implant which causes the breast implants to harden (similar to what a contracted muscle feels like). The cause of capsular contracture is unknown, but it is the most common complication with breast augmentation surgery. There are different grades of capsular contracture ranging from mild to severe. The rate of capsular contracture has decreased from 20-30 years ago when all breast implants were placed above the muscle (sub-glandular). By placing the breast implants below the muscle (sub-muscular), the rate of capsular contracture has significantly decreased. Also, it is said that massaging of the implants helps decrease the chance of capsular contracture. When a patient is believed to be developing capsular contracture or hardening of the breasts, they may be placed on a medication called Accolate. This is an asthma medication that has shown to improve capsular contracture in patients at an early stage.When a patient develops severe capsular contracture, the treatment would be to return to the operating room and perform a capsulectomy on the patient. There is a chance that the capsular contracture may return after the revisionary breast surgery. AlloDerm has been shown to help reduce the chances of encapsulation occurring again.
Breast Implant Rippling or Palpability
When a patient doesn’t have much breast tissue or body fat, they may experience palpability of the breast implants and possibly rippling of the breast implants. Although the breast implants are placed under the muscle (sub-muscular), the outer edge and cleavage areas are not covered by the muscle and these are the most common places where rippling is experienced. The rippling / palpability of the breast implant can be decreased by using silicone gel breast implants versus saline filled breast implants. Silicone gel breast implants are now FDA approved and give a softer, more natural feeling to the patient with little breast tissue. AlloDerm adds another layer between the implant and the skin which help prevent the chance of rippling or palpability from occurring.
Breast Implant Malposition/Displacement
Bottoming Out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. It is the loss of internal implant support where implant placement with partial, or no, muscle coverage, allows slow downward migration of the implants. This is because support of the implant by the skin alone is not always enough to prevent downward migration of the implants. Also, over-dissection of implant pockets at the time of surgery may cause immediate bottoming out. This is corrected by “raising” the inframammary fold using internal sutures. This is done after careful measurements are made from the areola to the “new” inframammary fold. To add another layer of support, preventing the implant from migrating down, AlloDerm is placed under the implant.
Lateral Displacement of implants causes the implants to migrate laterally causing the nipple areola complex to appear too far out to the sides of the breast. The support of the implant by the skin alone is not always enough support to prevent lateral migration of the implants. To add another layer of support laterally, AlloDerm is placed on the sides of the breasts between the skin and the implant to help prevent lateral displacement.
One of the more common problems that patients are seeking Dr. Pousti’s help for is symmastia. Symmastia – commonly referred to as “bread-loafing” or “uni-boob”, occurs when two implants touch one another in the center of the chest. If the horizontal muscle that is connected to the sternum and goes across the implant is cut during surgery, then the implant can move toward the middle of the chest. Symmastia results from overly aggressive attempts to alter chest wall anatomy trying to increase cleavage in patients. This outcome is made worse by use of larger implants in thin patients, and is a problem for implants over or under the muscle, though sub muscular implant placement allows the muscle to provide some softening of the transition to the cleavage area from the augmented breast mound. AlloDerm is used to prevent medial displacement of implants by adding support to the skin and creating an additional layer between the implant and the medial pocket.
Support/Coverage for Breast Augmentation/Breast Lifting Patients
AlloDerm can be used to add an additional layer of support between the patients skin and the breast implant. Although the breast implants are placed under the muscle (sub-muscular), the outer edge and cleavage areas are not covered by the muscle, leaving them at risk for displacement. By adding the additional layer of AlloDerm, the implant is provided with more support and coverage.
Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast. Another common problem that we see in our office is the need for AlloDerm Regenerative Tissue use to help cover the implant when the pectoralis muscle has been damaged and is not giving enough coverage to the area.
After your consultation, if Dr. Pousti decides that AlloDerm would assist in your reconstruction, he will discuss the procedure in detail and go over all of the potential risks and complications associated with the procedure.
Dr. Pousti has used AlloDerm for several patients with wonderful results.
This patient has had trauma to the pectoral muscle and needed a large piece of AlloDerm for coverage.
Above is before Revisionary Surgery.
Above is days after Revisionary Surgery with AlloDerm.
Another patient needed to use AlloDerm to get better coverage due to the fact that the implant was very close to the surface.
As seen here, the implant is dangerously close to the surface on the right side.
This patient is extremely happy with her results.
Resumption Of Physical Activities:
Driving may be resumed in 1-2 weeks.
Non-contact sports in 3 weeks.
Contact sports in 6 weeks.
Not From San Diego? Fly In!!
Since Dr. Pousti is an expert in AlloDerm use for breast reconstruction, many women from around the country choose to fly to San Diego to obtain his services. If you are not from the San Diego area, please visit Fly in for Surgery to learn more about our out-of-town accommodations and scheduling information.
Hi to Dr. Pousti and Staff I could go on and on, but I tried to make this testimonial as concise as possible for future patients. First let me thank all of you from the bottom of my heart!! Thank you for caring the way that you have
I’m writing this for anyone considering breast augmentation surgery, or anyone who is coming to Dr. Pousti for revision surgery. I moved to San Diego in August of ‘06 and new that finding a doctor to do my revision surgery was a main priority for me. I had lived with a previous complication for two years with increasing difficulty as it kept getting worse and worse. The hardest part of the process for me was learning to trust a surgeon again after my past experience. I’m 23 and had already had two surgeries, and the amount of emotional stress I had for the past two+ years had worn me down. I found Dr. Pousti online and came in for a consultation within a couple weeks of moving here. After meeting with him, looking at pictures online, and reading patients testimonials, I knew he was the man for me!! (Not to mention his wonderful staff)
I had a pretty serious/complicated issue (take a look at the before and after pics!) I was pretty much hopeless that I would ever be anything but deformed… and yet Dr. Pousti. didn’t turn me away, instead he worked with me and did research on new techniques in breast revision surgery using AlloDerm Regenerative Tissue. He went out of his way to help me, and treated me like and individual person instead of a paying customer. I will be forever grateful for the extra effort he put into my case It’s now Feb ‘07 and I am more than a month out of surgery, the revision surgery went better than I could ever have imagined. He did an amazing job!!
One thing I would like to add because I think it is a common misconception with female patients, is about male surgeons. I know that after having a male doctor for my first two surgeries I was frustrated because I felt like men didn’t take the time to listen to me, and (with my young appearance) treated me like a child. So before meeting Pousti I had consulted with a female surgeon in the area thinking maybe that was the answer… I was wrong, she was actually worse than my previous surgeon, and made assumptions about what I wanted and didn’t want without asking me. In short, It’s not about a male doctor or a female doctor, it’s about the person. I would strongly recommend him to anyone considering cosmetic surgery, honestly he is a very talented surgeon. If you are consulting with him because you are facing a revisionary surgery, he is someone you can trust, he’s completely honest, and he really does care about his patients. Best of luck with your future surgery
Dr. Pousti and Staff,
After suffering a serious injury to my pectoral muscle, I found myself in need of surgery and recognized after evaluation by several other plastic surgeons, that my case would be difficult with an unpredictable outcome. I began to search for the doctor to be found that is the best to do the repair- I finally located you after extensive research. Your familiarity of the use of AlloDerm as your replacement tissue and your amazing artistic ability has truly been my saving grace. My “revisionary” surgery has proven far superior and much more beautiful than my original augmentation. I wish I had found you years ago for the original implants, but I feel blessed to have you now. My trip from Arkansas was so worth while! Wonderful staff- Awesome you!
I am the significant other of this patient (above). I would like to express my sincere thank you for such a great job. The original augmentation was less than satisfactory and the injury sustained was drastic, as you well know and the results of your work outshine that tremendously. She is very happy and as a result has a much better outlook regarding her appearance. She was always great to me regardless and still is. I thank you once again for your skill and judgment in regards to sizing, shape, etc. I feel that you have captured the perfect essence of her femininity with your work, I am sure in the month to come as she heals that your work will only become better as well.. once again thank you for your time, patience, skill, and personal attention to her when she first contacted your office and staff. At the very beginning she was so distraught and after talking to everyone there became much more relaxed and assured that she was in good hands.
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