Tissue Expansion: Further Attempts to Improve Results in Breast Reconstruction

Tissue expansion, is a simple method of breast reconstruction. Method. A prospective study of 27 patients treated over a 43 month period is described. At the first stage the expander is inserted in the dual plane, and the medial pectoral nerve is divided. The tissue expander is over-expanded. Second stage: a de-epithelialized vertical triangle is used to aid anterior projection, an inframammary fold is created and a silicone gel prosthesis inserted. Z-plasties are added to the transverse scar. The contralateral breast can be treated or left alone. Complications were recorded and the results were assessed by 4 plastic surgeons using a visual analogue scale. Results. 19 patients had expanders inserted at mastectomy (2 bilateral) and 8 underwent delayed reconstruction, with a mean age of 47 years (range 30–65 years). A single prosthesis was inserted in 15 patients (mean size 320？mL) and two prosthesis were stacked in 12 patients (mean volume of 400？mL). The mean delay from full expansion to the second stage was 10 weeks (range 3 weeks–11 months). A contralateral augmentation was performed in 5 patients, pexy in 10, a reduction in 2 and in 8 patients no procedure was performed. One patient required explantation. The mean visual analogue assessment was 7. Conclusion. This technique should be considered enhance the cosmetic results in tissue expansion. 1. Introduction Tissue expansion is still a popular technique of breast reconstruction [1–7]. Advantages include a quick, relatively simple procedure without donor site morbidity. Additionally, the colour and the texture of the reconstructed breast skin is identical to the contralateral breast [1–8]. It is often considered a two-stage procedure [1–8]. Tissue expanders can be placed electively, as part of a delayed breast reconstruction, or more recently, at the time of nonskin sparing mastectomy. As the mastectomy removes both the nipple-areola complex and breast skin, this skin envelope is reduced in surface area. Tissue expansion allows the skin envelope to be recreated. Historically, tissue expanders were placed in a total submuscle pocket [8]. However, the expander (and subsequent prosthesis) was often displaced upward by muscle action, leading to an asymmetrical reconstruction. More recently, the expander has been placed in a “dualplane” with improved aesthetic results [1, 9–11]. This paper concerns 27 patients undergoing two-stage tissue expansion over a 43-month period. A number of manoeuvres have been performed in an endeavour to enhance the cosmetic result. 2. Material and Methods All patients having