Tissue Expander Complications Do Not Preclude a Second Successful Implant-Based Breast Reconstruction

Abstract

Background: Implant-based breast reconstruction is the most common method of breast reconstruction in the United States, but the outcomes of subsequent implant-based reconstruction after a tissue expander complication are rarely studied. The purpose of this study was to determine the long-term incidence of implant loss in patents with a previous tissue expander complication.

Methods: This is a retrospective review of the long-term outcomes of all patients with tissue expander complications at a large academic medical center from 2003 to 2013. Patients with subsequent tissue expander or implant complications were compared to those with no further complications to assess risk factors for additional complications or reconstructive failure.

Results: One hundred sixty-two women were included in this study. The mean follow-up period was 8.3 ± 3.1 years. Forty-eight women (30 percent) went on to undergo a second tissue expander or implant placement. They did not differ from women who went on to autologous reconstruction or no further reconstruction. Of these, 34 women (71 percent) had no further complications and 38 women (79 percent) had a successful implant-based reconstruction at final follow-up. There were no patient or surgical factors significantly associated with a second complication or implant loss.

Conclusions: Following tissue expander complications, it is reasonable to offer women a second attempt at tissue expansion and implant placement. This study demonstrates that long-term success rates are high, and there are no definitive patient or surgical factors that preclude a second attempt at implant-based breast reconstruction.

Clinical question/level of evidence: Risk, III.

Figure 1:

Study Design and Statistical Analyses TE = tissue expander

Figure 2:

Patient with bilateral failed tissue expanders successfully reconstructed with second episode of tissue expanders followed by implants. A. Preoperative frontal view prior to skin-sparing mastectomies. B. Preoperative oblique view prior to mastectomies. C. Frontal view of tissue expanders explanted on both sides following skin-sparing mastectomies, immediate subpectoral tissue expanders with acellular dermal matrix slings, and subsequent infection 67 days later. D. Oblique view of tissue expanders explanted on the both sides. E. Frontal view three years following bilateral tissue expanders followed by silicone smooth round breast implants and nipple-areola reconstructions to salvage failed tissue expander reconstructions. F. Oblique view three years following bilateral tissue expanders followed by implant exchanges and nipple-areola reconstructions.

Figure 3.

Patient with failed tissue expander reconstructed with autologous flap. A. Preoperative frontal view prior to mastectomies. B. Preoperative oblique view prior to mastectomies. C. Frontal view of tissue expander explanted on the left side following radiation therapy. Right sided tissue expander remains. D. Oblique view of tissue expander explanted on the left side following radiation therapy. E. Frontal view two years following deep inferior epigastric artery perforator (DIEP) flap performed on left to salvage failed tissue expander reconstruction. Implant exchange on right and bilateral nipple-areola reconstructions also performed. F. Oblique view two years following DIEP flap (left), implant exchange (right) and bilateral nipple-areola reconstructions.

Figure 4:

Patient Inclusion and Outcomes Flowsheet TE = tissue expander