Revisional Reconstructive Surgery

kf23

I had a bilateral mastectomy with tissue expanders placement in June 2015. Chemo followed, then the expanders were replaced in Nov 2015 with implants. Radiation treatment took place subsequently ... on the left breast only. I have asymmetric breasts. The left is very, very hard and high up while the left is lower and larger and way softer. I have been consulting with plastic surgeons on the best approach to modify/revise my current condition. I have been receiving many of the same thoughts, but also some very different recommendations. It's hard for me to make sense of all things without having studied this topic for a decade or more as the experts have. That said ... right now, I am interested in learning more about the use of "acellular dermal matrix (ADM)" on a radiated breast.

One progressive surgeon told me that the capsular contracture that can occur with any implant is far less likely to occur with the use of ADM. I know that my original surgeon used 'some' ADM with my original implant surgery, but I don't know how much he used. I also do not know what the impact of the radiation treatment had on the ADM. I do know that my asymmetry was present even with the tissue expanders prior to any radiation treatment.

HELP? Who has had experience with ADM?

SeattleBound

I will be watching for your answers, too. The randomized research studies are few on most reconstruction topics which makes our job in finding the right procedure and doctor very difficult. Most studies have too few participants and/or are not randomized with a control group to yield meaningful results. It seems to be a situation where a given surgeon's skill level and experience lead to preferences/biases. My husband is a physician who has access to online sites with research and medical journal articles, so he has helped me research my options. I developed capsular contracture on one side, too. The implant on the other side has migrated toward my underarm. Both were placed under the muscle. I did not have radiation and no ADMs were used. From the information that is most recently available, I decided to seek prepectoral implant placement with round, smooth silicone implants and ADM or other material to help with retaining implant position. Of 3 previous plastic surgeon consults, each used a different product. Not an exacting science yet!