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Which Breast Reconstruction Method Is Best?

Early this month I attended the BC3 conference in Washington, DC.  The B stands for Breast, and the Cs for Cancer, Coordinated, Care.  There were so many incredible advancements.

In this and future blogs, I will share with you my perspective on a few of them that you might hear about  in the doctor’s office or when you discuss things with your peers.  It’s important to always understand your options to best formulate your care plan.

Prepectoral vs. Under the Muscle Reconstruction

Surgery options for those having reconstruction with implants can make a huge difference in cosmetic results and physical capabilities like participation in sports or fitness activities.

Historically, implants have been placed under or behind the muscle, or “pocketed” using a combination of the pectoralis (chest) muscle and a sheet of material called acellular dermal matrix, or ADM. Surgeons offer one step (direct to implant) or expansion technique in multiple steps. The protection of the implant and reconstruction creates a new (artificial) breast on the chest where a natural breast would sit.

Women with implants placed under the muscle often complain of a strange feeling when they activate the stretched pectoralis muscle.  And they can actually see an animation deformity or rippling contraction across the chest when they put their hands on their hips and contract.  Women complain that wearing a bathing suit or scoop neck can make them feel self-conscious of this deformity.

Dr John Hijawi, a breast surgeon from Salt Lake City, explained at the conference that by putting an implant over the muscle (prepectoral), women retain the ability to use their pectoral muscles for sports and fitness activities such as skiing, cross-fit (think push-ups and burpies), and weight training.

The prepectoral approach involves the same mastectomy procedure—removal of all of the breast tissue, but obviates the need for an expander. Patients can avoid a second procedure, often necessary when the implant is placed under behind the muscle.

To secure the implant over the muscle but under the skin, the surgeon wraps the entire implant in acellular dermal matrix and tacks this into place.  After about 6 weeks, the matrix begins to integrate into the patient’s own tissues and makes a soft and secure pocket.

Dr Hijawi reports that contracture, or development of a tight and fixed shell around the implant, is  much less likely with this approach because the implant is completely surrounded by a ADM pocket, not just a partial covering as in “under the muscle” technique.

About ADM (Acellular Dermal Matrix)

About 25 years ago, a company called Lifecell launched a new product called Alloderm to support and protect areas of the body and implants where tissues had been removed and weaknesses created.  Alloderm, an ADM, or acellular human dermal matrix gently processed from donated and carefully screened human tissue, has revolutionized breast reconstruction. When sutured into the breast pocket, it readily integrates with the patient’s own tissue, allowing for rapid return of blood vessels and healing, minimizing inflammation and scarring.

Because ADM does not contain any human cells, just the “scaffolding” of tissue, there is virtually no risk of rejection, infection or contamination.  Your own cells and blood vessels just grow right into it.

ADM can be used in dental procedures, abdominal wall reconstruction, orthopedics, breast reconstruction and many more applications throughout the body.

It is exciting to learn about new techniques and approaches in medicine. I hope this proves to be even more natural and life-improving for women facing difficult health decisions.

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