Two-stage delayed breast reconstruction with an expander and free abdominal tissue transfer: Outcomes of 65 consecutive cases by a single surgeon
Journal of Plastic, Reconstructive & Aesthetic Surgery, 08/19/2011
Tadiparthi S et al. – The two–stage breast reconstruction using skin expansion and autologous tissue transfer eliminates the need for a visible skin paddle and produces a sensate breast with a more natural–looking breast mound.Methods
- Consecutive patients who underwent the two-stage reconstruction between 2004 and 2010 were included in the study.
- Data were collected retrospectively on patient demographics, adjuvant treatments, surgical procedures and outcomes.
- A total of 65 patients who initially had a non-skin sparing mastectomy underwent two-stage breast reconstruction, of which the majority were delayed (n = 63, 95%) and unilateral (n = 64, 98.5%).
- Each patient was individually assessed for their suitability for the two-stage reconstruction.
- In 89% (n = 58) of cases, the expander was inserted in a subcutaneous pocket, while in the remaining a subpectoral pocket was elected.
- After the first stage, seven complications were recorded (10.7%), notably three expander extrusions, three seromas and one implant infection.
- Of the 65 patients, 63 proceeded to the second stage of reconstruction with 38 transverse rectus abdominis myocutaneous (TRAM) (60%), 12 superficial inferior epigastric artery (SIEA) (19%), and 13 deep inferior epigastric perforator (DIEP) (21%) flaps.
- Mean follow-up time since the completion of the second stage was 42 months (range 6–80 months), with complete flap loss recorded in 4.6% and minor fat necrosis in 9.5% of cases.