Regenerative tissue for reconstruction

Regenerative tissue is tissue donated from humans or other mammals, or tissue-like material created in a lab, that supports your body in developing its own new cells and tissues.

Regenerative tissue can include donated skin, nerve, or other body tissue.

One form of regenerative tissue, called acellular dermal matrix or ADM, is often used in implant breast reconstruction surgeries. ADM tissue:

• Helps keep the implant in the right position
• Provides a support framework for your own cells to grow and form new tissue
• Reduces the risk of scar tissue tightening around an implant (capsular contracture)

By taking on your cells, ADM is more likely to be accepted by your body as natural body tissue.

ADM is not currently FDA-approved for use in breast reconstruction, but surgeons use it very frequently off-label in breast reconstruction. Off-label means ADM can still be used in breast reconstruction based on:

• Strong scientific evidence
• Your individual medical history
• Your surgeon’s evaluation
• An understanding of the benefits and risks

Not all implant reconstructions use ADM. If you are considering implant reconstruction, it’s important to talk about the risks and benefits of ADM for your unique situation.

How regenerative tissue is prepared

There are different kinds of regenerative tissue that can be used in breast reconstruction, and they are prepared and treated before use.

Acellular dermal matrix (ADM) preparation

Surgeons use ADMs to add tissue to the breast area and cover the implant.

An ADM is created by first taking human or animal tissue from a donor after the donor has died.

After the tissue is removed from the donor, it is processed and prepared:

• The donor’s cells and other material are removed, leaving only a structure of mostly collagen, a protein found in the skin, that formed around the cells.
• This purifies the tissue and makes it possible for your body to recognize it as safe, and to start adopting it as your own skin.

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

Nerve graft preparation

Nerve repair procedures are sometimes used as part of breast reconstruction. This is because mastectomy cuts nerves in the chest, causing temporary or permanent numbness.

A procedure called Resensation uses donated nerve tissue called a nerve graft. Surgeons use the nerve graft to connect cut chest nerves to nerves in the reconstructed breast. Over time, some sensation may return.

Preparing donated nerve tissue for use in breast reconstruction is similar to ADM preparation:

• The nerve tissue is cleansed
• The donor’s cells and other material are removed
• The nerve is sterilized

You can learn more about nerve repair techniques on the Breast reconstruction page.

Regenerative tissue in breast reconstruction

Regenerative tissue such as ADM is used mainly in implant reconstruction, not tissue reconstruction. Nerve graft regenerative tissue can be used in both kinds of breast reconstruction.

ADM and similar regenerative tissues can help address some of the risks of implant reconstruction, including these:

• 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.
• Implant reconstruction can also involve tissue expanders. Tissue expanders are inflatable, temporary implants that stretch the skin and tissue left after mastectomy to make space for a permanent implant. For people having reconstruction, expanders can be uncomfortable or even painful.
• Implants can sometimes cause visible rippling.

To address these issues, ADM can be used in different ways during single-stage or two-stage reconstruction, or to fix past reconstruction problems.

Single-stage implant reconstruction

In single-stage (sometimes called direct-to-implant) reconstruction, surgeons attach ADM or other regenerative tissue to the chest muscles. The implant is placed during the same surgery. With this method, the implant is supported, and a tissue expander is not needed.

In the past, single-stage implant reconstruction with regenerative tissue was limited to women with:

• Small- or medium-sized breasts
• Breasts that did not sag very much
• Skin with good elasticity (stretchiness)

Now, this type of single-stage surgery is more available to women with different breast sizes and levels of breast sag. This is because surgeons now have:

• Better technology for evaluating skin blood supply
• Newer techniques to preserve the living tissue that can cover the implant

Two-stage implant reconstruction

In two-stage implant reconstruction, surgeons attach regenerative tissue such as ADM to the chest muscles with stitches during a first surgery. This forms a pocket that can hold a tissue expander.

The stitches are designed to dissolve, and the regenerative 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.

Fixing past reconstruction problems

ADM and other types of regenerative tissue can be used to correct breast reconstruction complications, such as:

• Rippling: deep wrinkles on areas of the breast
• Bottoming out: breast implants that sink too low
• An implant placed too close to the other breast

It can also be used to redefine the crease underneath the breast (the inframammary fold).

To fix these issues, pieces of regenerative tissue are stitched to the muscle to hold the implant in the proper place.

Learn more about corrective techniques in Secondary breast reconstruction procedures.

Cost of regenerative tissue

Using regenerative tissue such as ADM in breast reconstruction can add significant cost to the procedure. 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 copay or coinsurance depending on your plan. Call your insurance company and ask what your plan’s policy is for covering regenerative tissue in breast reconstruction.

Regenerative tissue side effects

Regenerative tissue in breast reconstruction can increase the risk of:

• Infection. Infections are often treated with antibiotics, but in more severe cases may require additional surgery. Tell your doctor right away if you have any redness, swelling, or pain at the surgery site.
• Seromas. Seromas are 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, your surgeon may need to drain it with a needle.

10 questions to ask your doctor

1. What are the benefits and risks of having implant 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 benefits and risks 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 implant reconstruction?
10. Are there any long-term issues I should watch for after surgery?