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Discussion: The Use of Acellular Dermal Matrices in Revisional Breast Reconstruction

I is a pleasure to discuss Drs. Slavin and Lin’s review of uses of acellular dermal matrices for revisional breast surgery. Indeed, the breadth of cases depicted attests to the versatility of this product and the creativity of the plastic surgeons employing it for revisions following implant procedures. First introduced in the 1990s, acellular dermal matrix quickly found its way into the hands of plastic surgeons in the treatment of burns, acquired deformities of the face and nose, lip augmentation, and abdominal hernia repair. In the early 2000s, reports appeared demonstrating the potential value of its use in treating implant-related complications, such as rippling and malposition (including symmastia and “bottoming out”), and as an adjunct to immediate breast reconstruction to improve lower pole fullness and shorten or eliminate the need for tissue expansion.1,2 As an indication of its popularity, acellular dermal matrix usage for breast surgery has grown to a nearly 250 million dollar market from nearly zero in 2006.3 Conceptually, the various applications of acellular dermal matrix for revisional breast surgery can be organized into five categories: