[Tissue expansion in mammary reconstruction and asymmetry. Apropos of 24 prostheses]

Based on a 24 mammary expansion implants performed in 14 cases of deferred breast reconstruction and in 7 cases of asymmetry, the authors analyze their results and indications according to data reported in the recent literature data. In breast reconstruction, expansion represents a relatively simple surgical procedure allowing an increase of local tissues without any additional scars. Its indications correspond to the gap left between simple prosthesis and musculo cutaneous flaps and are based on a clinical analysis of the volume and quality of mammary tissues considering that radiotherapy constitutes more factor of morbidity than a real contra-indication. A strict selection of patients allows reduction of the complications (6% prosthesis extrusions and 6% contractures in this series) that remains quite high (30%) in the literature. Based on two main operative steps, the reconstruction needs, in the great majority of cases, several complementaries operative sequences increasing to 2.4 in their series, and to 2.6-2.8 the average number of operative steps in literature. For breast asymmetry, expansion was correlated in this series to a higher incidence of complications and especially capsular contractures, leading to a limitation of their indications to cases in which the benefit is maximal in relation to an important glandulocutaneous deficit. These indications are in which hypoplasia with superointernal malposition of the nipple areola complex where the effect of expansion is maximal in the inferointernal mammary area and tubular and tuberous breasts, in which expansion allows a widening of the base of the breast and breaks the fibrous ring at the base of the breast.