Regenerative tissue reconstruction

In medicine, regenerative tissue is the use of donated tissue from humans or other mammals, or tissue-like materials created in a lab, to help the body recover from disease or major trauma. Rather than simply replacing tissue from your body with new material, regenerative tissues encourage healing and the development of new tissue. This relatively new technology is used in caring for burns, wounds and surgeries.

One form of regenerative tissue, called acellular dermal matrix or ADM, has become popular in breast reconstruction surgeries that use an implant. The ADM tissue helps keep the implant in the right position, and can adopt your own skin cells. By taking on your cells, ADM is more likely to be accepted by your body as natural body tissue. ADM is not currently approved by the FDA for use in breast reconstruction, but surgeons make it available off-label.

Regenerative medicine & regenerative tissue

Regenerative medicine – the umbrella under which regenerative tissue falls – takes many forms. Broadly, it includes any therapy that creates living tissue to repair damage caused by a disease, injury, or other condition. Researchers are currently exploring whether regenerative medicine can help create small arteries, skin grafts, cartilage and other human tissues that are often damaged. ADMs, the type of regenerative tissue used in breast reconstruction, are already in use for abdominal wall surgeries and to treat severe burns.

In breast reconstruction, regenerative tissue is available as an option when the person chooses to use implants to rebuild their breast. ADMs are a treated skin tissue used by surgeons to add tissue to the breast area and cover the implant. An ADM is created by taking human or animal tissue from a donor that has died. (Most companies today use human tissue, though at least one uses tissue from pigs.)

After being removed from the donor, the tissue goes through a process that removes the donor’s cells and other material and leaves only a structure of mostly collagen, a protein found in the skin, that formed around the cells. Purifying the tissue in this way makes it possible for your body to recognize it as safe and to start adopting it has your own skin.

The cleansed ADM is placed during surgery and takes on your cells to become part of your body tissues.

Regenerative tissue in breast reconstruction

After breast cancer surgery many women choose to have their breast rebuilt through breast reconstruction. One common way this is done is by using an implant, containing either a silicone gel or saline solution, to mimic the look and feel of your natural breast. There are also methods that use tissue from other parts of your own body to reconstruct the removed breast.

Reconstruction with an implant can pose some challenges for surgeons. The breast tissue left after mastectomy may not support the implant properly, causing it to sink too low or slip too close to the other breast. The reconstruction process also involves stretching the skin and tissue left after mastectomy to make space for the implant through the use of tissue expanders. For people having reconstruction, using expanders can vary from very uncomfortable to painful.

Two-surgery reconstruction

Regenerative tissue is used by surgeons to better control the placement and look of implants. In two-surgery reconstruction, the ADM tissue is attached with stitches to the chest muscles during a first surgery to form a pocket used to hold an expander. The stitches are designed to dissolve and the ADM tissue becomes part of your body, taking on your own cells and connecting to blood vessels and other material needed for living tissue. The expander is then inflated over the course of a few months before you have a second surgery to remove the expander and have the implant placed.

Single-surgery reconstruction

ADMs have also made single-surgery reconstruction an option for some women. In single-surgery reconstruction, the ADM is attached to the chest muscles and the implant is placed during the same surgery. With this method, you don’t need an expander.

Single-surgery reconstruction with ADM works best in women who had small or medium breasts before breast cancer surgery, whose breasts did not sag significantly, and whose skin has good elasticity. You’ll need to have a nipple-sparing mastectomy, a mastectomy that leaves the skin, nipple and areola intact, to have enough tissue for this surgery. This option also limits the implant size you can choose to either small or medium.

Fixing past reconstruction problems

Regenerative tissue can also be used to correct breast reconstructions that had complications such as

• “rippling,” deep wrinkles on areas of the breast
• “bottoming out,” breast implants that sunk too low
• an implant placed too close to the other breast

As in its use for reconstruction, to fix these issues pieces of regenerative tissue are stitched to muscle to place and hold the implant in the proper spot.

A 2015 study published in the journal Plastic and Reconstructive Surgery Global Open surveyed members of the American Society of Plastic Surgeons and found that more than 80 percent regularly use regenerative tissue in breast reconstruction.

• Most named greater control over implant position and better appearance as reasons they use regenerative tissue.
• About 40 percent said it results in fewer cases of capsular contracture, a tightening and hardening of tissue around the implant.
• Another 25 percent said they liked that using it resulted in fewer deformities.

Cost of regenerative tissue reconstruction

Today, regenerative tissue reconstruction can be expensive compared to other breast reconstruction options. The PRS Global Open article priced regenerative tissue for breast reconstruction at $3,500 per breast in 2015 — this is in addition to the costs of the implant, the procedure and other associated medical costs. Many health insurance plans now accept regenerative tissue as “medically necessary” and will cover at least part of the cost, but you may still have a high co-pay or co-insurance depending on your plan. Call your insurance representative and ask what your plan’s policy is for covering regenerative tissue to help you make your reconstruction decision.

Side effects

The use of ADMs in breast reconstruction has been found to increase the risk of infection and seromas, pockets filled with clear fluid that form under the skin. Most seroma cases are minor and will go away on their own. If the seroma is large, it may need to be drained by your doctor with a needle.

Infections are often treated with antibiotics, but in more severe cases may require additional surgery. Tell your doctor about any redness, swelling or pain that you have at the site of the surgery so he or she can check for infection.

10 questions to ask your doctor

1. What are the pros and cons of having breast reconstruction with regenerative tissue?
2. How long does my body need to heal and accept the donor tissue?
3. Will you use tissue from a human or an animal? What are the pros and cons of each?
4. How likely is it that my body will accept the donor tissue?
5. Do you have experience working with regenerative tissue in breast reconstructions?
6. Will using regenerative tissue increase the chances of a complication?
7. What happens if there is a complication?
8. Will my insurance cover the cost of the regenerative tissue?
9. Am I a good candidate for single-stage reconstruction?
10. Are there any long-term issues I should watch for after surgery?