Rapid versus slow tissue expansion for breast reconstruction: a three-year follow-up

Twenty-eight women scheduled for a breast reconstruction with tissue expansion were randomly divided into two groups. In the first group, the breast tissue was expanded rapidly, i.e., starting 1 week postoperatively on a daily basis; in the other group the breasts were expanded slowly, i.e., starting after 2 weeks, once each week. The expansion periods were 14 and 37 days, respectively. In both groups, the expansion volume was about 200 percent of the final breast prosthesis. The expanders were replaced by textured, gel-filled implants after 3 months. Follow-up examinations were performed after 1 year and 3 years to evaluate breast softness. An objective method, applantation tonometry, was used, and relative breast compressibility was calculated. The capsular contraction rate after 1 year was 45 percent in the rapid expansion patients and 23 percent in the slow expansion patients; after 3 years, it was 31 percent in the rapid expansion group and 33 percent in the slow expansion group. There was no statistically significant difference between the two groups at any time. Irradiated patients included in the study did not achieve poorer results. The results already obtained after 6 months remained stable up to 3 years after the implantation of the permanent prosthesis.