Surgeries for breast reconstruction
and application of ADM
Medical&scientific affairs team
Ji-hye Lee
Acellular Dermal Matrix (ADM)
Normal Human Skin
Acelluar Dermal Matrix
(ADM)
Remodeled Skin
 Remove epithelial layers
 Decellularization = removing cells inside of dermis
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Various Type of ADM Products
 FREEZE-DRIED ADM
(CGDerm)
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•
•
Rehydration (20 min)
Store at RT
No sterilization
 CYRO-PRESERVED ADM
(CGCryoderm)
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•
•
Thawing (5 min)
Store under -40 °C
No sterilization
 Hydrated ADM
(Alloderm-RCT)
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•
•
Ready to use
Store at RT
Sterilization
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Breast anatomy
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Breast surgery
 Breast reconstruction
: Surgery to functionally reconstruct the breast lost
by breast cancer
 Breast augmentation
: Surgery to make more normal and beautiful
breasts for excessively small breasts
Breast reconstruction
 Reduction mammaplasty
: Surgery to make excessively large breasts more
beautiful in shape and size
Breast augmentation
 Mastopexy
: Surgery to make more normal and beautiful
breasts for struck breasts
Reduction mammaplasty
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Stages of breast cancer
Radiotherapy
Chemotherapy
Partial mastectomy
Modified radical mastectomy
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Types of mastectomy
Radical mastectomy
Modified radical mastectomy
Simple or total mastectomy
Traditional mastectomy
Skin-sparing mastectomy
Nipple-sparing mastectomy
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Types of mastectomy
Partial mastectomy
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Types of Breast Reconstruction
1. By reconstruction type
1) Implant based breast reconstruction
2) Autologous breast reconstruction
2. By timing of reconstruction
1) Immediate breast reconstruction
2) Delayed breast reconstruction
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Classification of breast reconstruction
according to reconstruction type
Expander-Implant
based breast
reconstruction
Implant based
breast reconstruction
Autologous
breast reconstruction
Reconstruction using
autologous tissue
Reconstruction using prosthetic implant
Description
Most commonly used method
for breast augmentation
Using an expander to stretch
the skin and then replacing the
implant for breast
reconstruction
Autologous tissue for FLAP
usually can be obtained from
abdomen, back, Buttocks or
inner thigh
Advantages
• Simple method
• No additional scar
• Can be performed on
patients who have
insufficient skin due to large
amount of excision
•
•
Less complication
Natural breast-likeoutcome
Increased risk of complication due to foreign object insertion
After surgery, shape of the opposite breast may be different
If there is not enough tissue left after mastectomy, the shape
of the breast may be awkward.
•
Prolonged time in surgery
and under anesthesia
Abdominal wall hernia or
weakness
Disadvantages
•
•
•
•
•
Tissue expansion requires
2~3 months
Needs second surgery
•
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Implant-based reconstruction
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Expander-Implant based reconstruction
After tissue expansion
After implant insertion
Nipple reconstruction
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Types of surgery according to
insertion position of implant
Advantages of prepectoral breast reconstruction is
1) reduction of recovery time
2) reduction of pain after surgery
3) reduction of risk for implant rupture
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Breast reconstruction using ADM
 Advantages
-
Reduction capsular contracture
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Reduction time for tissue expansion
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Simple surgery method
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Improving the contour of the breast
= Increased patient satisfaction
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Reduction pain after surgery
 Disadvantages
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Increase risk of seroma
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Increase risk of infection
(The increase in seroma is closely related to the increase in infection)
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Capsular contracture
 Capsular contracture is a response of the immune system to foreign materials in the
human body.
 In normal condition, the membrane is formed around the implant because of the
implant is foreign materials. (membrane = capsule).
 When the capsule is contracted, it is a problem.
 Most frequently occurred complication after breast reconstruction.
 Malposition, deformity, implant rupture, pain etc.
 Requires revisional surgery (breast reconstruction after capsulectomy)
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The use of ADM for two stage
breast reconstruction
First stage-tissue expansion
ADM
 ADM is mainly used for immediate breast reconstruction rather than
for delayed breast reconstruction.
(If the patient has history with radiotherapy, implant and autologous tissue or only
autologous tissue has been used in delayed breast reconstruction)
 Apply ADM when expander implantation
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Subpectoral BR vs prepectoral BR
 Using relatively small amount of ADM
 Shorter operation time than when using
autologous tissue
 Faster recovery than when using autologous
tissue
 Pain reduction
 Lower seroma incidence
 Faster recovery than when using autologous
tissue
 Simple surgery
￭ Subpectoral BR using ADM.youtube
￭ Prepectoral BR using ADM.youtube
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Use of ADM for prepectoral BR
 Totally wrap implant using ADM
 For the intervention surgery due to serious
capsular contracture
 Can reduce capsular contracture
Before
After
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Features of CGcryoderm 1
A product 1)
1) A
product : freeze-dried ADM
CGcryoderm showed similar tissue density and structure with normal skin
rather than freeze-dried ADM product. (1)
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Features of CGcryoderm 2
CGcryoderm showed similar elasticity and tensile strength compared to the
normal skin. (2)
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Features of CGcryoderm 3
CGcryoderm showed slower degradation by collagenase compared to other
products. (3)
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Features of CGcryoderm 4
CGcryoderm showed lower seroma incidence after breast reconstruction
compared to the freeze-dried type ADM. (5)
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Features of CGcryoderm 5
CGcryoderm possesses higher amount of ECM components including collagen
and hyaluronic acid than an e-beam sterilized RTU product. (4)
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Other indications
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ADM for STSG
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ADM for STSG
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Case 1
Clinical application of a new dermal substitute to the radial forearm free flap donor site.
(A)A 53-year-old man had a 5×6 cm raw surface on the left radial forearm after flap elevation.
(B) (B) CGDerm was immediately applied to the defect area.
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(C, D) After 18 months, the surface of the CGDerm grafted area was cosmetically satisfactory, and there was not
impairment during excursion of forearm flexors.
Case 2
(A)An 8-year-old girl had a hypertrophic scar on the dorsum of her right foot.
(B, C) Immediately after excision of the hypertrophic scar, CGDerm graft and an autologous skin graft were undergone
on the defect site.
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(D) Twenty-four months later, positive cosmetic and functional results were reported.
Rotator cuff tear
Animation
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