Table 3. Types of alloplastic adjuncts in breast reconstruction.

Alloplastic adjunct	Product name		Material		Sterility		Use		Contraindications		Other
Acellular dermal matrix
Allograft		AlloDerm® (LifeCell Corp, Branchburg, New Jersey, USA); AlloDerm® Ready to Use (LifeCell Corp., Branchburg, New Jersey, USA)		Cadaveric		Non-sterile, aseptic;		• Freeze dried or pre-hydrated;		• Potential allergen—multiple antibiotics are used in product processing		• Most documented in literature
								• Orientation specific;
								• Infero-lateral sling;
						Terminally sterilized		• Immediate implant or expander based reconstruction;
								• Nipple reconstruction;
								• Shelf life 2 years
		FlexHD® (MTF/Ethicon, Somerville, New Jersey, USA)		Cadaveric		Non-sterile, aseptic		• Pre-hydrated;		• No information available (NIA)
								• Orientation specific;
								• Mainly used for abdominal reconstruction;
								• Shelf life 3 years
		DermaMatrix® (MTF/Synthes, West Chester, Pennsylvania, USA)		Cadaveric		Non-sterile, aseptic		• Freeze dried;		• Not recommended in patients with autoimmune connective tissue disease
								• Orientation specific;
								• Immediate implant or expander based reconstruction;
								• Shelf life 3 years
		AlloMax™ (Bard, Warwick, Rhode Island, USA)		Cadaveric		Terminally sterilized		• Freeze dried;		• NIA
								• Not orientation specific;
								• Immediate implant or expander based reconstruction;
								• Shelf life 5 years
		DermaCell® (Lifenet, Virginia Beach, Virginia, USA)		Cadaveric		Non-sterile, aseptic		• Ready to use;		• Sensitivities to gentamicin and vancomycin
								• Orientation specific;
								• Nipple reconstruction;
								• Shelf life 2 years
Xenograft		PermaCollTM (Covidien, Boulder, Colorado, USA)		Porcine		Terminally sterilized		• Pre-hydrated;		• Sensitivities to porcine tissue
								• Not orientation specific;
								• Mainly used for abdominal reconstruction;
								• Not recommended for breast reconstruction due to inadequate laxity
		StratticeTM (Lifecell, Branchburg, New Jersey, USA)		Porcine		Terminally sterilized		• Pre-hydrated;		• Sensitivities to porcine tissue		• Highest stiffness and tensile strength of all the acellular dermal matrices (ADMs)
								• Not orientation specific;
								• Mainly used for abdominal reconstruction;
								• Shelf life 18 months
		SurgiMend® PRS (TEI Biosciences, Boston, Massachusetts, USA)		Fetal Bovine		Terminally sterilized		• Pre-hydrated;		• Sensitivities to bovine tissue
								• Not orientation specific;
								• Shelf life 3 years
Synthetic mesh		TiLOOP® Bra (PFM Medical, Cologne, Germany)		Titanium coated polypropylene mesh		Terminally sterilized		• Infra-mammary fold like shape;		• Not suitable for revision surgery
								• Comes in three sizes;
								• Mainly available in Europe—not yet approved in the United States as of July 2013
		TIGR Matrix Surgical Mesh (Novus Scientific Pte Ltd, Singapore)		Fast-degrading (copolymer of glycolide and trimethylene carbonate) and slow-degrading (copolymer of lactide and trimethylene carbonate) fibers		Terminally sterilized		• Long term, absorbable, macroporous knitted mesh;		• Higher complication rates in irradiated patients
								• Retains mechanics for up to 9 months;
								• Totally hydrolysed by 3 years
		Knitted Vicryl Mesh (Vicryl, Ethicon, Somerville, New Jersey, USA)		Polyglactin 910		Terminally sterilized		• Absorbable;		• Higher complication rates in irradiated patients
								• Ready to use;
								• Cheap and widely available;
								• Minimum inflammatory response and non-allergenic