25.0: Thursday, March 17, 2005

Immediate Breast Reconstruction with Integrated Valve Tissue Expanders and Alloderm: An Evolution of the Subpectoral Placement

Christopher V. Pelletiere, MD and Scott L. Spear, MD.

In 2004, we reported on our findings with placement of expanders for breast reconstruction in the partial submuscular position. Our complications were equivalent to total muscle coverage, yet criticism was leveled at the fact that a portion of the expanders were covered by nothing more than mastectomy flaps. Because of this, we looked to reinforce the lower pole of the breast with Alloderm. Thirteen patients underwent immediate breast reconstruction with integrated valve expanders and Alloderm between June and September, 2004. Augmentation of the inferior pole provides multiple benefits. By securing the superior edge of the Alloderm to the elevated pectoralis muscle, a pocket is created for the expander, eliminating the need for total muscle coverage. By securing the Alloderm to the inframammary fold site, the expander is seated at the proper level, providing a sharp inframammary fold. In the short-term, Alloderm acts as protection under possible compromised flaps. Overtime, the Alloderm is incorporated, becoming integrated and providing an added layer over the long term implant. While follow-up has been relatively short to date, this is the beginning of a process that may help patients who need reinforcement of the lower pole without placing the devices completely submuscular.