ADM also provides less known advantages for implant-based breast reconstruction . ADM placed at stage 1 (tissue expander placement) of two-stage implant-based breast reconstruction creates a tissue plane for injection of fat grafts into the lower mastectomy skin flap during stage 2 (exchange for permanent implant), which without ADM, is not always possible. Fat grafting shows promise in potentially decreasing the morbidity and improving the outcomes of implant-based reconstruction in the setting of radiation.

ADM also allows for intraoperative saline filling of the expander allowing for a more ptotic-shaped breast after radiotherapy, which subsequently enables the surgeon to place the implant directly into the breast skin pocket. ADM-enabled intraoperative saline filling of the expander also avoids the need for postoperative expansion and delayed initiation of radiotherapy in patients who receive neoadjuvant chemotherapy. The ADM not only increases the thickness of mastectomy skin flaps directly, but its use enables intraoperative saline filling and avoids thinning already thin mastectomy skin flaps, which can be treacherous in patients undergoing radiotherapy. At stage 2, during the exchange for the permanent implant, the thicker radiated mastectomy skin will provide better implant coverage than without ADM. The thicker mastectomy skin flaps that are being attained with ADM along with fat grafting have decreased the need for the addition of a flap, like a latissimus dorsi flap, for implant-based breast reconstruction. However, an equivalent safety profile has not yet been shown. The science indicates that ADM used along with fat grafting holds promise for improving the outcomes and safety of implant-based breast reconstruction, especially in the irradiated breast.