Alloderm, or another acellular dermal matrix (ADM) is used in most implant based breast reconstructions. Commonly after the mastectomy is completed, the skin flaps are very thin. While some surgeons try to use a full muscle coverage over the expander or implant, I feel along with other surgeons, that the implant or expander sits better in the pocket when the pectoralis muscle is freed inferiorly as is done in most submuscular breast augmentations. Because the skin flaps are thin, there is always concern that the implant may become exposed. ADM’s are commonly used to cover the lower pole of the implant to limit the risk of implant exposure and also to maintain the breast fold.