Current State of the Art for Acellular Dermal Matrices in Breast Surgery

The use of acellular dermal matrices (ADMs) in breast surgery has been transformative over the past decade. For implant-related problems, they can provide a unifying solution to the multiple issues stemming from inadequate tissue for coverage and support. The concept of a living internal bra is a compelling one for patients and plastic surgeons alike. Challenging problems such as implant rippling, malposition, and capsular contracture have all found a potential solution with ADMs. Extending this concept to reconstruction, ADMs have helped define a new model. Along with increasing use of skin- and nipple-sparing mastectomy, the availability of BRCA genetic testing, and better implants, many patients now achieve superior outcomes with mastectomy than with “breast-conserving” treatment with radiation and lumpectomy. Many thoughtful innovators have contributed to these developments, and this issue of the Clinics in Plastic Surgery is dedicated to those forward-thinking surgeons.

Controversies remain and so I have encouraged the contributors to this issue to take a balanced view. Indications for use are not rigorously defined for every potential application despite the utility demonstrated by broad clinical experience, and prospective trial data where they exist often lack clearly delineated inclusion/exclusion criteria. This issue addresses the current state of the art with ADMs in breast surgery and I hope will provide some guidance as the science evolves.

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