A REVIEW OF 120 BECKER PERMANENT TISSUE EXPANDERS IN RECONSTRUCTION OF THE BREAST

In reconstructive breast surgery, the permanent tissue expander has be come popular because it avoids expander-implant exchange and gives the patient some control over the final breast size. It may, however, be associated with a number of complications. We therefore analysed the c linical notes of 111 consecutive recipients of Becker breast expanders with respect to complications and their possible predisposing factors . 120 prostheses were inserted in 111 consecutive patients with a mean age of 42.6 years. Median follow-up was 12 months (range 8 to 22). Th e commonest indication was postmastectomy breast reconstruction (81%) followed by congenital hypoplasia (14%) and acquired breast asymmetry following repeated biopsies (3%). Overexpansion before size adjustment was achieved after an average of 8 expander inflations. Complications included capsular contracture (9%), local tumour recurrence (8%), wou nd dehiscence (8%), filling port failure (6%), infected prostheses (4. 5%) and ruptured implants (1.6%). The significant predisposing factors to wound dehiscence/infection were heavy smoking and radiotherapy (P less than or equal to 0.05, chi(2) test). Expansion rate was not a fac tor. 89% of patients expressed satisfaction with the final aesthetic r esult. Despite the excellent results obtained with this technique, cau tion must be exercised in heavy smokers and the previously irradiated.