Immediate breast reconstruction in two stages using anatomical tissue expansion

Over the last four years, 43 modified radical mastectomies and 13 simple ma stectomies were done for 56 patients with breast cancer followed by immedia te reconstruction in two stages using anatomical tissue expansion. In 49 pa tients a permanent prosthesis was successfully implanted while three patien ts refused a further operation, and four required removal of the expander. Complications were seen in 21 cases, including infection (n = 4), Baker III -IV contractures (n = 5), radiodermitis with breast distorsion (n = 3), and seroma (n = 2). Four patients required removal of the expander, and no fur ther attempts were made to reconstruct the breast. All 10 patients given ra diotherapy developed some kind of complication. After a mean follow up of 2 .5 years (range 6-48 months), the aesthetic result was rated 6.9 and patien t satisfaction 7.8 on a 0-10 scale. We concluded that immediate breast reco nstruction with anatomical tissue expansion gives predictable aesthetic res ults, which satisfied most patients. Although the complication rate is high , it does not exceed complication rates associated with mastectomy alone or delayed reconstruction. At present, only patients undergoing preoperative or postoperative radiotherapy and hesitant patients are not considered to b e candidates for this procedure.