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Alloderm® Tissue Matrix Stretch in Breast Reconstruction
PURPOSE: In this study we evaluated the in situ stretch properties of Alloderm® regenerative tissue matrix used in breast reconstruction. Alloderm® has gained popularity because of ease of use, more rapid and predictable restoration of the breast mound and better control of the lower pole of the breast. Existing knowledge confirms that Alloderm® used in abdominal reconstruction can stretch substantially. This level of knowledge does not exist for use in the breast. This information will help surgeons better understand how the tissue martix functions in breast reconstruction. These properties can be exploited to improve patient outcomes. Biophysical measurements were supplemented with patient based findings to provide a more complete picutre of tissue matrix breast reconstruction.
METHODS: A prospective case series protocol was developed. 3 mm vessel ligaclips were attached to the 4 corners of the matrix and also at 3 cm intervals along the superior edge of the matrix graft prior to implantation for tissue expander breast reconstruction. The ligaclips were imaged using ultrasound. Measurements were recorded on postoperative day 1, at one month (during expansion) and three months (at the completion of expansion). These measurements allowed for calculation of perimeter and surface area of the graft. Breast-Q™ validated patient questionnaire was administered at the termination of the study.
RESULTS: A total of 31 patients completed the study. Mean initial area of the implanted tissue matrix was 71 + 22 cm². At 3 months, post-expansion, mean area was 88 + 28 cm². This represents a 24% increase. Surface area changes ranged from 4% to 35%. Change in matrix size at 3 months, did not correlate with initial breast size, initial size of matrix graft, matrix thickness or completed breast expander volume. We were also interested in indetifying which regions of the matrix changed the most with expansion. The medial and lateral quarters of the graft combined were responsible for 70% of the total graft expansion. Breast -Q™ results were equivalent between the test group and a control cohort that did not receive matrix for reconstruction. Although not statistically significant, the matrix group trended toward a higher satisfaction score for appearance and less pain.
CONCLUSION: Our study suggests that Alloderm® acellular tissue matrix used in breast reconstruction does stretch. On average there is more than 20% increase in surface area over the course of expansion. In general, smaller grafts were associated with less stretch. Most the graft expansion and stretch occurred medial and lateral as opposed to centrally. Presumably the graft is compensating for the absence of muscle in these regions. The benefit of acellular dermal matrix in implant breast reconstruction may be its role providing consistent and reliable interface in these peripheral regions.