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Filling-Port Complications in Becker Expanders

Farace, Francesco M.D.; Faenza, Mario M.D.; Sanna, Manuela M.D.; Campus, Gian Vittorio M.D.; Rubino, Corrado M.D.

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Plastic and Reconstructive Surgery: February 2012 - Volume 129 - Issue 2 - p 386e-387e
doi: 10.1097/PRS.0b013e31823aef0c
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Sir:

Figure
Figure

Despite being in use since 1984, Becker implants still do not have a clearly defined role in plastic surgery. Several studies13 have demonstrated how Becker expander implants are more prone than other breast prosthetic implants to short- and long-term complications, necessitating additional surgical procedures. These findings are related mainly to the greater structural complexity of the prosthetic device itself, leading to a prolonged manipulation by the operator. We performed a retrospective study on 82 consecutive patients with 100 anatomically shaped Becker-35 implants used for breast reconstruction to highlight problems and complications and to better define their indications.

Postoperative complications leading to an extra surgical procedure occurred in 21 percent of the implants. One implant was removed for a nonspecific inflammatory reaction (1 percent), five implants were removed for infection (5 percent), one implant was replaced for a nonspecific deflation (1 percent), five implants were replaced for an immediate intraoperative deflation after port removal (5 percent), one implant was replaced for deflating and leaking from the connection tube (1 percent), two implants were replaced for postoperative rotation (2 percent), and six port displacements/rotations (6 percent) needed surgical repositioning (Table 1).

Table 1
Table 1:
Complications Responsible for Implant Removal

Most of our findings are in line with the international literature; however, there is a group of complications that appears to be more represented than expected: malfunction of the connection system retention valve/tube filling port. This system seems to be prone to potential leakage at any of its joints. In our study, we also found a lack of retention of the valve located in the anatomical prosthesis despite having removed the lug at the recommended times (2 percent). In addition, there may be causes that prevent filling, such as valve rotation or port calcification. Furthermore, we want to focus on this little known and poorly described valve complication and point out that it is mandatory to remove the filling port tube within 6 months after implantation. The Mentor Corporation states that “It is recommended that the duration of expansion not exceed six months as tissue adhesions may make it difficult to easily remove the fill tube or compromise valve integrity. Damage to the implant may result. ... Upon achievement of the desired expansion result, the fill tube and injection dome must be removed.”4 This limitation greatly reduces the believed postoperative adjustable “force” of the Becker expander.

It should also be noted that Becker implants cannot be filled and/or deflated for years and then have the valve removed without any risk of deflation. This is an ingrained practice in those who regularly use Becker implants to correct breast deformities,3 to counter the onset of capsular contracture or to obtain higher breast ptosis.

It would therefore be advisable to reduce use of the Becker expander implant only to cases not eligible for reconstruction with expander and permanent prosthesis, such as in bilateral cases5 or in patients older than 65 years. In any event, we must always specify that if tube removal does not occur within 6 months, the whole reconstruction is at risk of failure. These data have led us to limit indications for use of the Becker implant and to change the postoperative filling protocol, and to provide the patient with a more careful and accurate informed consent.

Francesco Farace, M.D.

Mario Faenza, M.D.

Manuela Sanna, M.D.

Gian Vittorio Campus, M.D.

Corrado Rubino, M.D.

Scuola di Specializzazione in Chirurgia Plastica Ricostruttiva, Università degli Studi di Sassari, Sassari, Italy

REFERENCES

1. Scuderi N, Alfano C, Campus GV, et al.. Multicenter study on breast reconstruction outcome using Becker implants. Aesthetic Plast Surg. 2011;35:66–72.
2. Chew BK, Yip C, Malyon AD. Becker expander implants: Truly a long term single stage reconstruction? J Plast Reconstr Aesthet Surg. 2010;63:1300–1304.
3. Camilleri IG, Malata CM, Stavrianos S, McLean NR. A review of 120 Becker permanent tissue expanders in reconstruction of the breast. Br J Plast Surg. 1996;49:346–351.
4. Mentor Corp. Mentor Becker Expander/Mammary Prostheses Product insert data sheet 102757-001 Rev. E Effective July 2002.
5. Gahm J, Edsander-Nord A, Jurell G, Wickman M. No differences in aesthetic outcome or patient satisfaction between anatomically shaped and round expandable implants in bilateral breast reconstructions: A randomized study. Plast Reconstr Surg. 2010;126:1419–1427.

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