Breast reconstruction by tissue expansion: What is the integrity of the chest wall?

Both tissue expanders and implants are commonly used during breast reconstructions. These devices are the preferred choice of many plastic surgeons around the world during breast reconstruction due to their technical ease of use, low comorbidity and safety. However, several issues such as the integrity of the chest wall during and after tissue expansion remain unclear. Here we present a longitudinal study that shows deformities of the chest wall caused by the use of tissue expanders.

A prospective longitudinal study of the chest wall in 36 patients who underwent immediate two-stage expander-to-implant reconstruction from 2010 to 2013 was conducted to evaluate the possible causes of chest wall deformity. Computed tomography (CT) scans of the chest walls were taken before the second-stage reconstruction and after 1 year. Chest wall deformities (graded from I, no deformities, to V, costal fracture) were evaluated with CT scans.

This study examined 36 breast reconstructions. Chest wall deformities were observed by a CT scan before the second-stage reconstruction. There were eight patients with grade I scores, 14 with grade II, 10 with grade III and four with grade IV. No cases of costal fracture (grade V) were observed. At the 1-year follow-up after the TE/implant change, 22 patients had the same degree of chest wall deformity. Ten patients showed an improvement and four a higher-grade deformity.

Chest wall deformities commonly occur after tissue expander/implant reconstruction. However, the size of the expander, reconstruction timing and filling volume are not correlated with deformity development.