A novel cost-saving approach to the use of acellular dermal matrix (AlloDerm) in postmastectomy breast and nipple reconstructions (original) (raw)

Plastic and Reconstructive Surgery, 2010

Abstract

Immediate two-stage breast reconstruction using a tissue expander and implant has evolved in sophistication to become the procedure of choice for many reconstructive surgeons treating postmastectomy patients. The modification of the immediate two-stage reconstruction using AlloDerm (Lifecell, Branchburg, N.J.) to create complete coverage of the tissue expander further enhanced this already reliable and effective approach. When used in this fashion, AlloDerm provides inferior pole coverage of a subpectorally placed tissue expander, allows higher initial fill volume, improves definition of inframammary fold, and results in less postoperative pain.1 AlloDerm has also been used in nipple reconstruction to tackle the challenge of projection loss over time. Although experience on nipple reconstruction with AlloDerm is limited, preliminary results are encouraging.2,3 The cost of AlloDerm can be prohibitive, especially when it is used in both breast and nipple reconstruction. For breast reconstruction, it costs 2100to2100 to 2100to3400 per breast, depending on the size selected. For nipple reconstruction, an additional 480to480 to 480to1500 is needed. Despite the Women’s Health and Cancer Rights Act of 1998, U.S. health insurance companies do not provide consistent coverage for the cost of AlloDerm in breast reconstruction, and at the time of writing of this article, none covers the cost of AlloDerm in nipple reconstruction. We describe a novel cost-saving approach that obviates the cost of AlloDerm in nipple reconstruction when the AlloDerm has already been used in the breast reconstruction.

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