There has been a major advance in breast reconstruction with the use of acellular dermis. Tissue expansion and implant reconstruction have produced good results for many patients but there have been problems for some. Now there is a new advance which can help patients with certain problems and even for some women allow them to have a single stage reconstruction . This advance is the use of acellular dermis . This is a product which is derived from human skin – the cellular elements are removed and left behind is strong matrix which can be used to provide an internal sling. This acellular dermis is used as an extension of the pectoralismajor muscle allowing coverage and support of the breast implant. It can be used with tissue expansion but it is really exciting that we now have for some women the choice of a single stage reconstruction. This product has also been helpful in correcting implant position problems as well as it has been used to add an additonal layer of coverage in areas of thin coverage over an implant.