The advent of acellular dermal matrices (ADMs) has changed the way implant reconstruction is performed and has opened the door to muscle-sparing techniques that can be performed as an NSM (nipple-sparing mastectomy) with DTI (direct to implant) with excellent cosmesis and less patient morbidity. The article discusses differences in types of ADMs and outlines some current strategies and controversies with ADM use.
Key points
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A well-performed nipple-sparing, or skin-sparing, mastectomy is the foundation of successful reconstruction.
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Techniques are evolving, and standard use of the pectoralis muscle and tissue expanders is in question.
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Acellular dermal matrix is both useful and cost-effective in performing immediate one-stage breast reconstruction.
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