What is Alloderm Breast Reconstruction?

By: Dr. Minas Chrysopoulo

Blogs
November 06, 2011

Alloderm is now being used routinely in breast reconstruction. Here’s what you need to know…

First off, what is it? AlloDerm is derived from donated (cadaveric) human skin. It is FDA approved and is used in many different types of reconstructive surgery including breast reconstruction. Before being packaged for use, the Alloderm undergoes a multi-step process that removes all the cells that can lead to tissue rejection: even though it comes from another person, your body does not reject Alloderm because the immune cells are removed. Alloderm essentially acts as a scaffold and over time, the patient’s own cells grow into it.

Since it is a human (cadaveric) product, the U.S. Tissue Bank rigorously screens all tissue donors’ medical records. All donors must be negative for Syphilis, Hepatitis B and C, and HIV 1 and 2. AlloDerm grafts are also examined under the microscope before and after processing to rule out contamination.

Alloderm is frequently used in implant-based breast reconstruction (and has been for years). The tissue expander or implant is placed under the pectoralis (chest) muscle. The more tissue coverage over the implant, the better the results. Unfortunately, the pec muscle cannot cover the entire implant. The Alloderm is used to cover the lower part of the implant that is not covered by muscle.

Advantages:
- Stabilizes the implant in position.
- Allows for complete implant coverage.
- Can allow the creation of a full-sized breast when the tissue expander/implant reconstruction is performed at the same time as the mastectomy.
- No risk of rejection.
- Once incorporated by the body, resists infection as well as the patient’s “natural” tissue.

Disadvantages:
- Like anything that is implanted in the body, there is an initial (low) risk of infection (until it becomes incorporated).
- Can cause temporary redness in the skin over the Alloderm (“red breast syndrome”).
- Costly but usually covered by insurance.

Many plastic surgeons, including myself, use Alloderm routinely when performing breast reconstruction with tissue expanders and implants.

Learn More About Implant Breast Reconstruction

10 Comments

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  • Claudia

    I am s/p day 5 skin and nipple sparring prophylactic mastectomy with allograft and silicone implant placement. I jave 2 days erythema surrounding 1-2 cm my left niple?

    Reply
  • PRMA Plastic Surgery

    Hello Claudla! It is important to follow up with your surgeon after surgery if you are experiencing anything abnormal. I highly recommend calling and letting your surgeon know what you are experiencing.

    Reply
  • Andy

    Heard about severe complications related to Alloderm. How far they can be avoided. Since the risk of infection is very high.

    Reply
  • Dr. Chrysopoulo

    Hello Andy. Thank you for your comment and Happy New Year! Some studies have shown the overall complication rate in tissue expander/implant breast reconstruction is higher when an acellular dermal matrix (ADM) such as Alloderm is used, particularly in terms of seroma (fluid collections) and infection. However, comparisons with traditional expander reconstruction generally have not shown statistically relevant differences in overall complication rates. Overall, complication rates for reconstructions using an ADM range from 3.2% to 48.7%. As you can see, that’s quite a spread! An important surgical goal in tissue expander/implant reconstruction is to completely cover the implant. Traditionally this has been achieved using only muscle - the pectoralis muscle to cover the upper part of the implant and the serratus +/- rectus abdominis muscle(s) to cover the lower part. This achieves complete muscle coverage but is also associated with significant post-operative discomfort and in many cases an unnatural lower breast shape. Alloderm and other ADMs are used to cover the lower part of the expander/implant instead of the serratus and rectus abdominis muscles. This helps achieve full implant coverage with less muscular dissection so the surgery tends to be less painful. The Alloderm also allows the surgeon to fill the expander (at least partially) when performing the reconstruction at the same time as the mastectomy. The expansion process can generally be completed at a faster pace. The final result also tends to be much more natural and aesthetic in terms of the shape of the lower breast. While all surgery has risks, I do feel that the risk of complications can be significantly reduced through improved patient selection, optimal surgical technique and evidence-based protocols. This approach significantly improves the likelihood of minimizing patient complications (ie 3.2% rather than 48.7%!) Overall, I feel the risks of using ADMs like Alloderm are very much outweighed by the benefits, which is why I use them in my practice. I hope this info helps! Dr C

    Reply
  • Jane

    I heard AlloDerm is less sterile than DermACELL. How should that impact my decision in terms of deciding which ADM to use?

    Reply
  • PRMA Plastic Surgery

    Hey Jane! Both companies use a proprietary method of processing the dermal tissue prior to implantation. Initially, Alloderm was considered “aseptic” as apposed to “sterile”. This led to some physicians questioning the safety of using Alloderm in the setting of implant reconstruction. Alloderm’s current processing method, to my understanding, is able to produce a product that is now “sterile”. All clinical studies comparing all types of acellular dermal matrix have not identified any statistical differences between products (Alloderm, Dermacell, FlexHD, etc…) in relation to infection, seroma, capsular contracture, etc… Essentially, all human-derived acellular dermal matrix products are the same. Hope this is helpful!—Dr. Ochoa

    Reply
  • Janice

    I had alloderm reconstruction on Jan 15, 2016 and developed red breast syndrome about a week later. I had no infection. But now, within the last 2 weeks, I have developed severe allergic reactions to food I normally was able to eat. I’ve made 2 trips to the emergency room to be treated for these (throat swelling, tongue, lips also swelling). What is the possibility that I am allergic to the ‘sterile’ alloderm that is in my body? What are signs of me rejecting the alloderm?

    Reply
  • PRMA Plastic Surgery

    Hey Janice! This is not something I have heard of, but I strongly recommend you follow up with the surgeon who performed your surgery to see if any tests can be performed to determine what is causing this.

    Reply
  • Jonda

    I had DCIS stage 1 no lymph node involvement ( although complete left arm & axilla node dissection) 9/99. 4 rounds of chemo. Since I had 13 bouts of lymphangitis from 3/00- 6/06, I felt strongly that reconstruction would be dangerous Or fatal. At 17 years post modified radical mastectomy, 4 rounds of chemo AC. And 10 years of no lymphangitis, I decided to go forward. I did not research Alloderm until now…. ofcourse S/P severe complications. Original Alloderm expander surgery 11/15/16. After 10 days of a jpeg drain, returned to surgeon x 3 for fluid aspiration. First time 4 days post drain removal 70 ccs seroussanguiness fluid aspirated in office. 2 days later 25 ccs. Aspirated in office. Two days later when feeling like fluid build up one day prior to long planned flight to Hawaii, surgeon “out of town” MA sent pictures to surgeon. .She said “Go on your scheduled holiday, I wouldn’t do anything if you were staying in town”. I had been on keflex since surgery, after 1st aspiration switched to clindamycin 300 mg po q 4 hours. I should have asked why. First 3 days in Hawaii, some surgical site pain, breast engorgement, some redness. Took video of breast & sent to office. Site was kept clean & dry. I went in to the ocean twice. Both times had site completely covered by tegaderm. Afterwards I immediately took shower, soaped, rinsed removed tegaderm then washed with hibiclens, swabbed with betadine , dried then covered with tape provided by office. On 12/21/16 stopped clindamycin (had been on since 11/21/16 & had severe diarrhea all this time) Plus, I was feeling fine, redness had subsided. on 12/24/16 suddenly became cold with rigors. Within one hour oral temp 104.1 F . Took 2 aleve 1 clindamycin. One hour later ( 5:30 pm MST) Temp 104.0 F. Breast hot, red , tender & felt like was going to “explode”. Admitted for observation & broad spectrum antibiotics . Plastic surgery consult ordered for am. At 8:00’pm plastic surgeon arrived, saw consult ordered decided more urgent than ER Dr suggested. He quickly scheduled surgical removal Of Alloderm. He said he never uses it, he has only removed them repeatedly! 75 + cc pus suctioned from site. Vigorous lavage with aggressive cleansing. Another jpeg placed. 5 days of inpatient. Sepsis, BPs 80/40. Complete fluid overload, 20 # water weight gain. Finally 72 hours later culture of fluid grew enterococcus faecilis. Switched to oral Augmentin. I still have jpeg. Have to wear very tight “corset ” with ABD pads. Still on Augmentin. Will see original surgeon 1/09/17. This all occurred While in MT for Christmas. The surgeon in MT says there are 2 schools of thought, some (he) NEVER uses Alloderm because of this problem. Others, always use it. I am so disappointed & feel so uneducated. After 17 years of living lopsided to this nightmare….. I highly doubt I will attempt this again. I will be seriously studying Alloderm. Also, enterococcus faecilis is highly resistant to Vancouver, Known to be nosocomial. Ofcourse I can’t help,but wonder if in office aspirations may have introduced this bacterium to site….. I am a RN & was very thorough with my wound care. I find it hard to believe that the bacteria was introduced under my watch. Ofcourse there is no way to prove/ disprove that. So much for the pretty bras/ swimsuits I thought I would get to wear.

    Reply
  • PRMA Plastic Surgery

    Goodness sweet Jonda! So terribly sorry you have been through all of this! Like you said, it is hard to say how the infection was introduced, but any time foreign objects are placed in the body there is a chance for infection. This includes the Alloderm and the Implants. We believe the gold standard for breast reconstruction today is the DIEP flap. This procedure uses your own living tissue to reconstruct a breast. This means no foreign bodies and no need to additional surgery 10 years down the road to replaced the old implants. I know you have been through a lot with your reconstruction and you may not be ready, but if there is ever a time when you are interested in more information or would like to speak to some of our patients who have had the surgery, we would be more than happy to help!

    Reply
PRMA Plastic Surgery