Two-stage expander implant reconstruction: recent experience

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.

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.

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.

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.