Risk Assessment for Early Complications in Nonbreast Tissue Expansion: 9-year Experience With 308 Tissue Expanders

Tissue expansion is a common and efficient reconstructive technique, yet associated with significant complications even for the most proficient reconstructive surgeon. Risk factors for complications have been described, but variability of the surgical technique and postoperative management of these patients as well as different definitions of the term "complications" make it difficult to interpret data impartially. This study evaluated the impact of demographic and operative parameters on early complications in tissue expander (TE) insertion surgery, using the Clavien-Dindo Classification (CDC) of Surgical Complications.

A retrospective review of all nonbreast TE insertion procedures between 2009 and 2018 was conducted. Univariate and multivariate logistic regression analyses were performed to identify risk factors for complications.

In total, 308 TEs were inserted. Median age was 7 years (1-46 y). The most common indication was congenital melanocytic nevus (72.1%). The early complication rate was 28.6%, but only 1.3% required pharmacological treatment and 6.8% required surgical intervention. Multivariate analysis identified a history of autoimmune disease/malignancy, larger drainage size, and a less experienced surgical team as being associated with a higher risk of complications (CDC 1-3b). Procedures conducted in a previously expanded area were associated with a higher risk of complications requiring pharmacological/surgical intervention (CDC 2-3b). Aplasia cutis congenita was associated with a higher risk of complications requiring surgical intervention (CDC 3).

We report several risk factors for complications following nonbreast tissue expansion, using a standardized classification of surgical complications. These may assist reconstructive surgeons in the management of this group of patients.