This is a corollary to my last journal article (from the September Plastic Surgery Journal article on radiation pre and post skin sparing mastectomy), but for those doing breast reconstruction with an implant, use of ADM is frequently done. ADM is acellular dermal matrix, and involves using a sheet of dermis usually from a cadaver or porcine model to “thicken” up the tissue and lend support to the underlying implant. Its use has become more popular in the last decade. There are complications which can happen with ADM use though, so the question always is, should we use it?
This is part of another study specifically looking at radiation effect on complications and tissue loss, but I thought these findings were important, so I wanted to share them here.
IF YOU HAVE RADIATION BEFORE YOUR MASTECTOMY, use of ADM was found to increase the risk of skin flap complications (loss of the skin, nipple areola), and had variable effects on infection. The thought was the radiation led to issues with the ADM incorporating into the tissue. Sometimes they still used ADM when it must be used to allow for expander coverage. In those patients, based on their findings, they now will do little to no expansion of previously radiated patients at the time of surgery.
IF YOU HAVE NOT HAD RADIATION BEFORE YOUR SURGERY, they found the ADM lowered the rates of infections, and had no effect on skin loss,wound breakdown, or implant loss. There are some doctors who feel the ADM helps the body withstand effects of radiation after the ADM is incorporated into the tissue. (Which means you need time to heal after your surgery before you start the radiation.)