Breast reconstruction (BR) may pose a challenge if the patient’s skin-pectoral muscle pocket cannot adequately support tissue expansion or hold the expander or implant in place. Various options exist for reinforcing coverage of this muscle, including autologous transplant of tissue from the latissimus dorsi and the blunt dissection and elevation of portions of the serratus anterior, rectus abdominis, or external oblique muscles; however, these options are associated with additional morbidity. An approach to improve outcomes following BR involves the use of an acellular dermal matrix (ADM) mesh-like material prepared from human cadaver or animal sources for single- and double-stage reconstruction procedures.
Description of Technology: Fetal/neonatal bovine dermis is the source tissue for SurgiMend. The product is composed of type I and type III collagen and is without preservatives, denatured proteins, artificial chemical crosslinks, cells, lipids, carbohydrates and other constituents, all of which can induce inflammation.
Patient Population: This health technology assessment focuses on adult women who undergo BR following mastectomy to treat or reduce the risk of breast cancer. Of note, SurgiMend is not indicated for use in this population according to the Food and Drug Administration.
Clinical Alternatives: The alternative to implant reconstruction is autologous flap reconstruction, where a portion of skin and fat (with or without muscle) is harvested from another part of the body (most commonly the lower abdomen but also the back, thigh, or buttock) and transplanted to the chest, where it is shaped into a breast. A number of alternative ADM products are commercially available.
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