Tissue expansion for breast reconstruction: Methods and techniques

Abstract

Objective: In this work, the authors review recent data on the different methods and techniques of TE/implant-based reconstruction to determine the complication profiles and the advantages and disadvantages of the different techniques. This information will be valuable for surgeons performing breast reconstructions.

Materials and methods: A thorough literature review was conducted by the authors concerning the current strategy of tissue expander (TE)/implant-based breast reconstruction following breast cancer surgery.

Results: Loss of the breast can strongly affect a woman's personal and social life while breast reconstruction reduces the sense of mutilation felt by women after a mastectomy, and provides psychosocial as well as aesthetic benefits. TE/implant-based reconstruction is the most common breast reconstructive strategy, constituting almost 65% of all breast reconstructions in the US. Although numerous studies have been published on various aspects of alloplastic breast reconstructions, most studies are single-center observations. No evidence-based guidelines are available as yet. Conventional TE/implant-based reconstruction can be performed as a two-stage procedure either in the immediate or delayed setting. Moreover, the adjunctive use of acellular dermal matrix further broadened the alloplastic breast reconstruction indication and also enhanced aesthetic outcomes.

Conclusions: TE/implant-based reconstruction has proved to be a safe, cost-effective, and reliable technique that can be performed in women with various comorbidities. Short operative time, fast recovery, and absence of donor site morbidity are other advantages over autologous breast reconstruction.

Keywords: Breast cancer; Breast implants; Breast surgery; Reconstructive surgery; Tissue expansion.

Fig. 1

Preoperative pictures (a, b) of a 46-year old patient prior to skin-preserving mastectomy and sentinel lymph node biopsy. (c) Intraoperatively, the expander can be seen within the submuscular pocket. The big arrow indicates the pectoralis major muscle, while the small one indicates the anterior serratus muscle. The final result after TE/implant exchange and secondary procedures (nipple-areola complex reconstruction and tattooing). (d, e).