PURPOSE:
To cover the infero-lateral breast implant not covered by the pectoralis major muscle and to control the implant position in breast reconstruction.
METHODS:
We used an acellular dermal matrix patch (Alloderm, 4x16 cm, 0.78-1.79 mm thick; LifeCell Corp., NJ) to extend the infero-lateral part of the pectoralis major muscle in 67 breast reconstructions in 43 patients after skin sparing mastectomies. By tailoring the width and position of the Alloderm^® inset, the degree of lower pole fullness and position of the infra-mammary fold were precisely determined. Choice of procedure was based on patient’s preference and activity level, anatomy and lack of autologous donor tissue.
RESULTS:
67 breasts were reconstructed from April of 2003 to November 2005. F/U ranged from 6 months to 3 years with no capsular contractures observed. Complications included 2 infections treated with wound debridement and i.v. antibiotics. One implant was lost due to extrusion after having received XRT prior to reconstruction.
CONCLUSION:
This technique reduces or eliminates the need for tissue expansion. It enables correction of post-reconstructive deformities such as capsular contracture or soft tissue failure after autologous reconstruction, allows for correction of certain congenital breast deformities and provides an additional option for single-stage breast reconstruction. It is safe and reproducible and is particularly useful in patients with skin sparing mastectomies.

Breast Reconstruction with infero-lateral Alloderm® Hammock

	Bilateral	Unilateral	Mean F/U ± SD (months)
Immediate with Expander-Implant	3	4	18.9 ± 11.2
Immediate with Silicone Implant	12	6	19.4 ± 16.9
Delayed with Expander-Implant	0	4	14.3 ± 3.8
Revision of Expander-Implant Reconstructions (Capsulectomy) with Silicone Implant	7	9	10.8 ± 3.8
Total Number of Breasts	44	23