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Two-Stage Expander Implant Reconstruction: Recent Experience

Strock, Louis L. M.D.

Plastic and Reconstructive Surgery: November 2009 - Volume 124 - Issue 5 - p 1429-1436
doi: 10.1097/PRS.0b013e31818b89da
Breast: Special Topic

Background: Two-stage tissue expander/implant breast reconstruction has become increasingly popular, but reports have varied widely in the incidence of complications associated with this approach. A large consecutive patient experience using low-height tissue expanders in immediate breast reconstruction is presented and discussed in conjunction with other recent reports using this approach following mastectomy.

Methods: A total of 172 consecutive patients underwent immediate breast reconstruction following mastectomy, with placement of a total of 246 tissue expanders. All expanders used were McGhan Style 133LV or Mentor Low Height Contour Profile devices. No patients had preoperative radiation to the mastectomy site. All devices were placed in a submuscular pocket, with the base of the device in a subcutaneous plane in the area of the inframammary fold. Patients either completed expansion with permanent implant placement or had a complication requiring implant removal or replacement.

Results: The overall complication rate was 10.5 percent. The most common complication was infection (4 percent), followed by malposition (3.5 percent), rupture (1.7 percent), extrusion (0.6 percent), and capsular contracture (0.6 percent). Patients with malposition, rupture, and capsular contracture underwent replacement with a device of the same type. Four patients with infection required device removal; one underwent delayed device replacement.

Conclusions: Low-height tissue expanders can be used in a consistent and predictable fashion in two-stage expander implant breast reconstruction, with complication rates comparable to those seen with moderate and full-height devices, and without limitations based on the type of permanent implant planned or the breast type to be reconstructed. Recent experience has shown that, while surgeons may prefer different expander device heights, the most important points are consistent use of expander devices with integrated ports, initial placement beneath the muscle, and tissue release to the subcutaneous plane in the inframammary fold area.

Fort Worth, Texas

Received for publication February 4, 2008; accepted August 22, 2008.

The consecutive patient series contained in this article was presented at Plastic Surgery 2006, the 75th Annual Meeting of the American Society of Plastic Surgeons, in San Francisco, California, October 6 through 11, 2006, in a presentation titled, “Controlling Shape in Breast Reconstruction Using Low Height Tissue Expanders.”

Disclosures: The author serves as a consultant to Mentor Corporation. He assisted as a noncompensated consultant in the design of the Mentor Low Height Contour Profile Tissue Expander. He has no financial interest in Mentor Corporation or in any product.

Louis L. Strock, M.D., 800 Eighth Avenue, Suite 606, Fort Worth, Texas 76104,

©2009American Society of Plastic Surgeons