title: Early Results Using Sterilized Acellular Human Dermis (Neoform) in Post-Mastectomy Tissue Expander Breast Reconstruction.
abstract: Acellular dermal products play a beneficial role in immediate tissue expander breast reconstruction. They provide improved coverage and support in the lower pole, allowing the pectoralis muscle to drape over most of the expander and maximize lower pole expansion. Tissue incorporation is desired without any adverse affects on recovery. The purpose of this series is to evaluate the early safety and morbidity of preserved human allograft dermis sterilized using the Tutoplast(R) process.All patients who underwent tissue expander reconstruction with NeoForm(R) at Emory University Hospital between 6/07 and 4/08 were included in the series. Patient demographics, risk factors, surgical technique, early complications and outcomes were evaluated.Twenty-two consecutive patients were included, with a total of 31 breasts (bilateral n=9, left n=9, right n=4). The average age was 48 years (range: 31-71), with an average body mass index of 26.7 (range: 19-35). Fifteen patients had a diagnosis of invasive breast cancer and 7 patients had DCIS. Risk factors included hypertension n=5, history of smoking n=2, diabetes n=1, and post operative radiation therapy n=8. All reconstructions were immediate with lower pole tissue expanders. NeoForm was rehydrated for appropriately 3-5 minutes. It was sutured superiorly to the lower border of the pectoralis muscle and inferiorly to the inframammary fold. The 4x16 size was used in 18 breasts, and 6x16 cm in 13 breasts. Early post operative complications occurred in one patient with native mastectomy skin necrosis. All drains were removed by the third post-operative week. There were no cases with infection, foreign body reaction, rejection, seromas, or skin erythema. Tissue expansion was performed without any difficult. Expander removal and secondary implant insertion demonstrated adequate incorporation of the NeoForm in 16 patients. Encapsulation of the Neoform, infection or extrusion was not observed.Acellular dermal products have become a useful addition to tissue expander breast reconstruction. NeoForm was successfully used for lower pole coverage of the tissue expander in 31 immediate expander breast reconstructions. Good tissue incorporation was observed clinically and there were no post operative complications that could be related to the NeoForm.
authors.affiliation: Atlanta, Ga. From the Division of Plastic and Reconstructive Surgery, Emory University School of Medicine.
authors.forename: Albert
authors.initials: A
authors.lastname: Losken