Consequences and Predictors of Prolonged Tissue Expander Duration in Breast Reconstruction

Abstract

Introduction: Tissue expanders (TEs) are temporary devices used in breast reconstruction, which are generally removed within one year. There is a paucity of data regarding the potential consequences when TE’s have longer indwelling times. Thus, we aim to determine whether prolonged TE implantation length is associated with TE-related complications. Materials and Methods: This is a single center retrospective review of patients who underwent tissue expander placement for breast reconstruction from 2015-2021. Complications were compared between patients who had a TE for > 1 year and < 1 year. Univariate and multivariate regressions were used to evaluate predictors of TE complications. Result: A total of 582 patients underwent TE placement and 12.2% had the expander for > 1 year. Adjuvant chemoradiation, BMI, overall stage, and diabetes predicted the duration of TE placement (p ≤ 0.006). Return to the OR rate was higher in patients who had TEs in place > 1 year (22.5% vs 6.1%, p < 0.001). On multivariate regression, prolonged TE duration was the only factor that predicted an infection requiring antibiotics, readmission, and re-operation (p < 0.001). Reasons for longer indwelling times included need for additional chemoradiation (79.4%), TE infections (12.7%), and requesting a break from surgery (6.3%). Conclusion: Indwelling TEs for > 1 year are associated with higher rates of infection, readmission, and re-operation even when controlling for adjuvant chemoradiation. Patients with diabetes, a higher BMI, advanced cancer stage, and those requiring adjuvant chemoradiation should be advised they may require a TE for a longer time-interval prior to final reconstruction.