Breast reconstruction by tissue expansion. A retrospective technical review of 197 two-stage delayed reconstructions following mastectomy for malignant breast disease in 189 patients

Despite the advent of free tissue transfer, breast reconstruction by tissue expansion is an important technique in the armamentarium of the reconstruc tive breast surgeon. The concept is deceptively simple and yet in reality c an produce difficult complications and poor results. A database was compile d of all the patients receiving tissue expanders and/or implants for cosmet ic, congenital and reconstructive purposes between 1986 and 1998. 189 patie nts had 197 delayed two-stage tissue expansion breast reconstructions follo wing mastectomies for malignant breast disease between 1986 and 1997. 103 b reasts (52%) had two uncomplicated stages. The remainder had one or more co mplications, revisional procedures for complications or alterations to the reconstruction for size, position or shape. Overall each breast reconstruct ion required 2.9 procedures (range 2-9). The complications and additional p rocedures are discussed. In particular, capsular contracture of the definit ive implant (12%) was related to implant type and not to the speed of tissu e expansion or the degree or duration of over-expansion. Although 17% of pa tients received radiotherapy, none of those who developed contracture aroun d the definitive implant had this adjuvant therapy, P < 0.05. Twelve recons tructions (6%) totally failed due to complications of which six underwent s econdary flap reconstruction. Twenty-one patients have subsequently develop ed metastatic disease of which 15 have died to date. Breast reconstruction by tissue expansion is still an important technique. It should be used carefully and thoughtfully by surgeons trained to deal wi th any complications. Patients need to be carefully selected and counselled prior to undertaking this process. (C) 2000 The British Association of Pla stic Surgeons.