A Prospective Randomized Study Comparing Two Different Expander Approaches in Implant-Based Breast Reconstruction

Abstract

Implant-based reconstruction is performed in the majority of women offered primary reconstruction for breast cancer. Two different expander implants were compared prospectively. The primary endpoint was the number of operations needed in each group to obtain patient satisfaction. Secondary endpoints were evaluation of breast volume and shape and aspects of quality of life. Seventy consecutive breast cancer patients were randomized to either a one-stage reconstruction with a round permanent expander implant (Becker 25; n=35) or a two-stage reconstruction with a crescent-shaped expander (LV 133; n=35), later replaced by a form-stable anatomical implant. Thirty patients had to be excluded and 40 patients, 20 in each group, were evaluated. The median follow-up for both groups was 3.5 years (range, 1.5 to 5 years). Plastic cups, plastic casts, and two -and three-dimensional scanning techniques were used for objective assessment of breast volume and shape. The aesthetic outcome was evaluated by a panel of experts and lay people, and by the patients. Quality of life was evaluated with a validated questionnaire (36-Item Short Form Health Survey). Of the patients in the one-stage group, 70 percent had revision surgery, mostly because of upper pole fullness and poor ptosis. These findings agreed with the data from the two-dimensional scanning and from the expert panel and the patients' subjective judgment. Quality of life was similar in the two groups. The permanent expander method failed significantly as a one-stage procedure. The crescent two-stage method gave the most acceptable results both objectively and subjectively. Therapeutic, I.