Acellular dermal matrix (ADM)

What is acellular dermal matrix?

Acellular dermal matrix is a biotechnological engineered mesh (graft) that acts as soft tissue support in a myriad of surgical purposes, but mainly, immediate implant-based breast reconstruction. Its purpose is to provide a scaffold upon which the patient’s tissue cells can grow and sufficient vascularised tissue can support the new breast implant.

The use of the mesh is usually chosen for women who have to undergo a nipple-sparing mastectomy and want an immediate reconstruction.

What is it made from?

The acellular dermal matrix is a thin, leathery, light-coloured material made up of dermis (living tissue) derived from cadaver human, porcine (animal) or bovine pericardium (collegen) tissue which has been specially treated for this procedure.

Why is it used?

Normally, there are two types of breast reconstruction options using implants. You can either use a tissue expander (which has two stages) or direct-to-implant (DTI) with acellular dermal matrix (which has just one stage).

The direct-to-implant with acellular dermal matrix is a new and alternative technique that provides lower support to the implant, enables faster tissue expansion and an improvement in the projection of the breast. In addition, its use allows for a mastectomy and breast reconstruction to be carried out in just one operation, as opposed to two, and the result is a more natural appearance of the breast with fewer complications.

What happens during the procedure?

During the operation, the acellular dermal matrix is placed in the lower part of the breast and is attached to the pectoralis muscle on the inferior lateral pole (lower sides of the breast). It creates extra space and support for the implant.

Once the implant is placed, the surgeon can then manipulate its position so that the resulting breast is more natural-looking. It achieves this by acting as a sling, or ‘hammock’ so that the implant can hang down, and thus creating a natural droop and shape to the breasts.

Who is a candidate for this?

Any woman who is due to undergo a mastectomy and a nipple-sparing breast reconstruction with implants is suitable for the use of acellular dermal matrix. However, breast cancer patients with nipple or skin involvement aren’t usually suitable.

Acellular dermal matrices are becoming more used by surgeons worldwide to provide quicker, more effective and natural-looking implant-based breast reconstructions.