Pie crusting of acellular dermal matrix may help decrease incidence of seromas in breast reconstruction

摘要

The use of human acellular dermal matrix as a valuable adjunct in implant based breast reconstruction has been well described over the years.1 It allows the accurate definition of the inframammary fold, better lower pole development, more volume to be placed in the expander and thus quicker and less expansions, in the two stage implant based breast reconstruction, the acellular dermal matrix is inset inferiorly to the inframammary fold and superiorly to the inferior edge of the divided pectoralis major muscle. The lateral edge of the acellular dermal matrix is approximated to the serratus anterior muscle and the lateral edge of the pectoralis major muscle to form a lateral pocket to prevent lateral migration of the expander. The acellular dermal matrix allows a complete subpectoral placement of the expander. Two drains are placed, one between the expander and the acellular dermal matrix and the other between the acellular dermal matrix and the lower mastectomy skin flap. These drains are removed when they are putting out less than 30 cc per day for two consecutive days.