Using alloderm w/o TE in NYC

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firebird25
firebird25 Member Posts: 5
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

Hello, my 58 y.o. mother is considering the direct to implant reconstruction following a bilateral mastectomy. This is a one step process without using tissue expanders and without a 2nd, replacement surgery using alloderm. Has anyone had this done? we're in NYC, and for some reason there's only one Dr. in NYC that does this procedure and only one group of plastic surgeons in Westchester that invented this approach in the first place that perform it. All the other plastic surgeons are reluctant to perform it.  Apparently the issue is that if too much alloderm is used there might not be enough blood supply to keep this donor tissue alive long enough until your body "grows" into it and it might turn to necrosis and will then need to be taken out, together with implants. Anyone know anything about it?

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  • Deirdre1
    Deirdre1 Member Posts: 1,461
    edited March 2011

    Well there is another issue, if your mom has bc and they put the final implant in the skin that held the original breast tissue (with the help of the Alloderm) it could be difficult for the tests (MRI, digital mammo etc) to see if another cancer or a recurrence of the DCIS has occurred.  Putting the implants behind the muscle (with a TE and fills) is the way to push the muscle forward and by doing that the tests can pick up a new cancer (or recurrence) easier.. Good luck!!! 

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  • firebird25
    firebird25 Member Posts: 5
    edited March 2011

    Deirdre1, with this method, the implant IS put behind the muscle!! But since the muscle isn't stretched, alloderm is used to cover the implant instead of your own tissue.

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  • Deirdre1
    Deirdre1 Member Posts: 1,461
    edited March 2011

    Ahh.. thank you - in the past Alloderm has been a "sling" for the new implant... I'm really glad that the implant is behind the muscle as it is suppose to be safer... 

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited March 2011

    Hi Firebird25,

    Sorry to hear about your mother. Dr. Ron Israeli is in Long Island and does the "one step" reconstruction. He was not my PS, but he comes highly recomented by a few of the woman here.

    Good Luck

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  • dalepaints
    dalepaints Member Posts: 3
    edited March 2011

    I have just had a Bi Lateral MX.. I am about your mom's age.  My 1st PS suggested an immediate implant and I thought it was a great idea until I went to get a second opinion. The second plastic person -- a woman--- suggested I rethink the immediate total implant b/c I  my skin is very thin and had stretch marks from nursing 2 children. I found her observations interesting and decided to go with her (in Boston). As it turned out she had to hand stitch the incisions b/c she was afraid the staples would not hold in my thin skin. I am having the sutures removed today!!  Condition of the skin is a very important consideration ...

    My one concern is the Alloderm.  I can feel it under my skin and if it does not soften I think I will have to have it removed as it is rather bothersome and I find myself holding by body stiffly to minimize movement.  I will get the low down on this today too.

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  • speech529
    speech529 Member Posts: 337
    edited March 2011

    I had this procedure last year (a unilateral).  The alloderm is acellular...that is there is no possibility of rejection for the donee.  Also, there is no blood supply to connect to your body.  This is not live tissue. The alloderm is sewn into the pectoraliz muscle as a way to support the implant.  The muscle tissue grows into the acelluar structure of the alloderm.  

    I am very, very pleased with the outcome for me.  But it is NOT for everyone. 

    The important part with the use of alloderm is the skill and experience of the surgeon in knowing WHO is a candidate for this type of surgery.  My PS said she does not perform this on women with large breasts (I was barely an A cup) and women whose skin is very stretched out.  

    I had my surgery done at Mayo in Scottsdale, AZ.  My BS and PS are highly skilled and have done this surgery many, many times.  I would not go to someone who does not think they can do it.

    I have posted my pictures on the TimTam photo site.  You have to private message her to get access that website.  

    to Dalepaint  The alloderm will get softer....it feels very stiff at first, then as you heal, massage and time passes, the breast drops nicely.  I am almost 9 months out and I love my breasts...one is my natural breast that is implanted and the other is reconstructed.  They feel the same to me and to my husband.  It takes time.  Hang in there!

    Good luck to all.

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  • Shrek4
    Shrek4 Member Posts: 1,822
    edited March 2011

    I had LD flap immediate reconstruction (skin-sparing BMX) with direct implants and Alloderm. At the revision, the PS used even more Alloderm. Doesn't feel hard under the skin, and the PS told me I will never need a bra for the rest of my life. My Alloderm slings were not used to cover the implant (I had 3 muscles total covering it) but to prevent the implant dropping too much or migrating under my arm or towards the chest-bone.

    One thing though, putting implants directly under the muscle without stretching the muscle first HURTS for a good 2-3 months.

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  • dalepaints
    dalepaints Member Posts: 3
    edited March 2011

    Well, I did jump to some conclusions that need to be rectified here.  I am only 4 weeks out of surgery and I thought it was the Alloderm I was feeling but ACTUALLY it is the internal stitches.  I have just begun massaging and it feels so much better! Both of my surgeons from Dana Farber are well respected in their field of breast surgery and breast reconstruction and that is all they do so I feel comfortable with them and their decisions.  There is so much to know!

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  • Shrek4
    Shrek4 Member Posts: 1,822
    edited March 2011

    You will feel lots of hardness in the beginning, from stitches to scar tissue. It will soften in time. Takes anywhere from 6 to 8 months before you get the full normal soft tissue all over the breast mound.

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