Breast Reconstruction: Complication Rate and Tissue Expander Type

Yanko‐Arzi, Ravit; Cohen, Michael J.; Braunstein, Rony; Kaliner, Ehud; Neuman, Rami; Brezis, M.

doi:10.1007/s00266-008-9192-0

Cited by 25 publications

(11 citation statements)

References 21 publications

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“…The tube between the smooth expander and the injection port can be ruptured intraoperatively. However, Yanko-Arzi et al 4 reported that integrated-port expanders are associated with more complications including expander rupture than the distant port. Multicenter studies with more patients are needed to elucidate the effects of expander type on complications.…”

Section: Discussionmentioning

confidence: 99%

“…There have been many studies examining risk factors for complications in expander-based breast reconstruction, and some patient factors (obesity, smoking, large breast size, and so on) have been identified as risk factors. 2 , 3 However, most of the previous studies reported statistical analyses based on Caucasian patients 1 – 4 ; there have been few studies based on Asian patients. Asian patients show physiological and lifestyle-related physical differences from Caucasian patients, such as lower rates of smoking and obesity.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Complications in Expander-Based Breast Reconstruction: Multivariate Analysis in Asian Patients

Suga

Shiraishi

Tsuji

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:There have been many studies examining risk factors for complications in expander-based breast reconstruction after mastectomy, and some patient factors have been identified as risk factors. However, most of the previous studies were based on Caucasian patients.Methods:Asian patients who had a tissue expander placed for immediate breast reconstruction between January 2006 and December 2015 (363 patients and 371 expanders) were analyzed retrospectively. Univariate and multivariate analyses were performed to elucidate risk factors for complications.Results:The rate of skin necrosis was significantly higher in nipple-sparing mastectomy than in other types of mastectomies (12 patients among 107 patients, P = 0.001). The weight of the resected specimen was significantly higher in the group with complications than in the group without complications (444 g compared with 363 g, P = 0.027). Other factors (age, body mass index, smoking, expander type, preoperative chemotherapy, axillary dissection) had no significant effect on complications. Multivariate analysis with a logistic regression showed that a large breast (over 500 g) was the only significant risk factor for complications, with an odds ratio of 3.20 and a 95% confidence interval of 1.33–7.54 (P = 0.010).Conclusion:In this series of Asian patients, breast size, rather than body mass index, is the most important predictor for complications in expander-based breast reconstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Complications in Expander-Based Breast Reconstruction: Multivariate Analysis in Asian Patients

Suga

Shiraishi

Tsuji

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“…Despite the primary role of LD reconstruction as a salvage procedure after a failed tissue expander, especially in cases of radiation therapy, there has been a renewal of interest in the use of tissue expanders with the LD flap as opposed to immediate implant placement [2,3]. The use and type of tissue expanders have also evolved over time [6]. Round tissue expanders were the first developed and are still often used in breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Use of the tabbed expander in latissimus dorsi breast reconstruction

Gust¹,

Nguyen²,

Hirsch³

et al. 2013

Journal of Plastic Surgery and Hand Surgery

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Latissimus dorsi (LD) myocutaneous flap breast reconstruction with a tissue expander/implant is a post-mastectomy option often used as a salvage procedure for a failed tissue expander (TE). The patient is traditionally placed in the lateral decubitus position for flap dissection and is re-prepped and re-draped in the supine position for placement of the tissue expander. A new generation of anatomically-shaped, tabbed tissue expanders are increasingly being used in place of traditional untabbed expanders. The innovative suture tabs allow for more predictable and controlled expander placement while the patient is in the lateral decubitus position, eliminating the need to reposition the patient intraoperatively. The objective of this study was to evaluate the use of tabbed tissue expanders in latissimus dorsi breast reconstruction, with respect to total operative time, complication rates, and aesthetic outcomes. The outcomes of 34 LD breast reconstruction procedures with tissue expanders were evaluated. Eight patients received tabbed tissue expanders with no position change, while 26 patients underwent an intraoperative position change. Demographic information, total operative time, and follow-up complication data were collected. Aesthetic outcomes were evaluated by three blinded individuals using a validated scoring scale. The mean operative time for procedures with no position change was 107 minutes. The mean operative time for position change cohort was 207 minutes. There was no statistical difference in complication rates or aesthetic outcomes between the two groups. In conclusion, tabbed tissue expanders decrease operative time by eliminating the need for an intraoperative position change without influencing complication rates while maintaining equivalent aesthetic outcomes.

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“…For these reasons, a subsequent post-reconstruction symmetry procedure is often necessary [17]. Further efforts to improve unilateral reconstructions led to the evolution in use and type of TE available [16,18], including the development of anatomically-shaped TEs [19-21], like those used in the present study, as well as anatomically shaped implants. Breast implants that are anatomically-shaped have been used for over a decade in Europe and South America [19,20,22] and were recently approved for use in the United States [23].…”

Section: Discussionmentioning

confidence: 99%

Tabbed Tissue Expanders Improve Breast Symmetry Scores in Breast Reconstruction

et al. 2014

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BackgroundAchieving symmetry is a key goal in breast reconstruction. Anatomically shaped tabbed expanders are a new tool in the armamentarium of the breast reconstruction surgeon. Suture tabs allow for full control over the expander position and thus inframammary fold position, and, in theory, tabbed expanders mitigate many factors responsible for poor symmetry. The impact of a tabbed expander on breast symmetry, however, has not been formally reported. This study aims to evaluate breast symmetry following expander-implant reconstruction using tabbed and non-tabbed tissue expanders.MethodsA chart review was performed of 188 consecutive expander-implant reconstructions that met the inclusion criteria of adequate follow-up data and postoperative photographs. Demographic, oncologic, postoperative complication, and photographic data was obtained for each patient. The photographic data was scored using a 4-point scale assessing breast symmetry by three blinded, independent reviewers.ResultsOf the 188 patients, 74 underwent reconstruction with tabbed expanders and 114 with non-tabbed expanders. The tabbed cohort had significantly higher symmetry scores than the non-tabbed cohort (2.82/4±0.86 vs. 2.55/4±0.92, P=0.034).ConclusionsThe use of tabbed tissue expanders improves breast symmetry in tissue expander-implant-based breast reconstruction. Fixation of the expander to the chest wall allows for more precise control over its location and counteracts the day-to-day translational forces that may influence the shape and location of the expander pocket, mitigating many factors responsible for breast asymmetry.

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Breast Reconstruction: Complication Rate and Tissue Expander Type

Abstract: The results of this study suggest that integrated-valve expanders are associated with more complications than the distant inflation port. The benefits of an anatomic shape may perhaps be better exploited using devices with a distant port.

Cited by 25 publications

References 21 publications

Risk Factors for Complications in Expander-Based Breast Reconstruction: Multivariate Analysis in Asian Patients

Risk Factors for Complications in Expander-Based Breast Reconstruction: Multivariate Analysis in Asian Patients

Use of the tabbed expander in latissimus dorsi breast reconstruction

Tabbed Tissue Expanders Improve Breast Symmetry Scores in Breast Reconstruction

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