Acellular dermal matrix (ADM) is a specialized mesh or graft engineered to provide soft tissue support in various surgical procedures, primarily immediate implant-based breast reconstruction. Its primary role is to serve as a scaffold for the growth of the patient’s tissue cells and to provide sufficient vascularized tissue to support the new breast implant.
What is ADM Made From?
ADM is a thin, leathery material composed of dermis, the living tissue layer of skin. It’s derived from cadaver human, porcine (animal), or bovine pericardium (collagen) tissue, specially treated for use in surgical procedures.
Why is ADM Used?
ADM offers a revolutionary approach to breast reconstruction, particularly in cases where a nipple-sparing mastectomy is performed. Unlike traditional methods that involve multiple stages, ADM allows for direct-to-implant (DTI) reconstruction in a single operation. This technique provides lower support to the implant, facilitates faster tissue expansion, and improves breast projection. Additionally, using ADM reduces the risk of complications, resulting in a more natural-looking breast appearance.
Procedure Overview
During surgery, ADM is placed in the lower part of the breast and attached to the pectoralis muscle on the lower sides. This creates additional space and support for the implant. Once the implant is in position, the surgeon adjusts its placement to achieve a more natural-looking breast shape. ADM acts as a supportive sling or “hammock,” allowing the implant to hang naturally and shape the breasts. It’s a versatile tool, also utilized in prepectoral reconstructions, where it wraps around the implant or tissue expander, securing with interrupted sutures to the pectoralis major muscle. This ensures enhanced stability, preventing any unwanted lateral shifting of the prosthesis.
Who is a Candidate for ADM?
ADM is suitable for any woman undergoing a mastectomy and nipple-sparing breast reconstruction with implants. However, patients with nipple or skin involvement due to breast cancer may not be suitable candidates for this procedure