Expander Prosthesis Research Articles

Expander prosthesis and DIEP flaps in delayed breast reconstruction: Sensibility, patient-reported outcome, and complications in a five-year randomised follow-up study.

Breast reconstruction is a given choice for many women following mastectomy. There are a multitude of methods available today, and thus, comparative studies are essential to match patients with suitable methods. The aim of this study was to compare 5-year outcomes following delayed breast reconstruction with expander prosthesis (EP) and with deep inferior epigastric perforator (DIEP) flaps. Seventy-three patients, previously randomised to either a permanent EP or a DIEP flap breast reconstruction, were invited for a 5-year follow-up. Assessments included symmetry measurements, breast sensibility with Semmes-Weinstein monofilaments and patient-reported outcome (PRO) with the BREAST-Q. Complications within the first 5 postoperative years were recorded. Additionally, BREAST-Q questionnaires were collected from non-randomised patients with an EP breast reconstruction. Between 2019 and 2022, 65 patients completed the follow-ups. Symmetry and PRO were significantly higher in the DIEP flap group. However, EP-reconstructed breasts were significantly more sensate and demonstrated areas with protective sensibility, unlike the DIEP flap breasts. The overall complication rates were comparable between the two groups (p = 0.27). Regression analysis identified body mass index as a risk factor for reoperation in general anaesthesia and for wound infection. No significant differences were found in a comparison of the randomised and the non-randomised EP groups' BREAST-Q results. This randomised 5-year follow-up study found PRO to be favourable following a DIEP flap reconstruction and sensibility to be better in EP reconstructions. The complication rates were comparable; however, longer follow-ups are warranted to cover the complete lifespans of the two breast reconstruction methods.

Acellular Dermal Matrix Cover Improves Skin Growth during Tissue Expansion by Affecting Distribution of Mechanical Forces.

Biological cover over tissue expander prostheses has been introduced to provide soft-tissue support for tissue expanders during breast reconstruction. However, its impact on mechanically induced skin growth remains unknown. This study investigates the hypothesis that covering the tissue expander with acellular dermal matrix (ADM) affects mechanotransduction without compromising the efficacy of tissue expansion. Tissue expansion, with and without use of ADM, was performed on a porcine model. The tissue expanders were inflated twice with 45 mL of saline, and the full-thickness skin biopsy specimens were harvested from expanded and control unexpanded skin 1 week and 8 weeks after the final inflation. Histologic evaluation, immunohistochemistry staining, and gene expression analysis were performed. Skin growth and total deformation were evaluated using isogeometric analysis. The authors' results demonstrate that use of ADM as a biological cover during tissue expansion does not impede mechanotransduction that leads to skin growth and blood vessel formation. Isogeometric analysis revealed similar total deformation and growth of expanded skin with and without a biological cover, confirming that its use does not inhibit mechanically induced skin growth. In addition, the authors found that use of an ADM cover results in more uniform distribution of mechanical forces applied by the tissue expander. These results suggest that ADM improves mechanically induced skin growth during tissue expansion by facilitating a more uniform distribution of mechanical forces applied by the tissue expander. Therefore, the use of a biological cover has potential to improve outcomes in tissue expansion-based reconstruction.

Evaluation of an assessment scale for aesthetic outcome in breast reconstructions based on digital photos in both 2D and 3D format

The aesthetic outcome is crucial in a breast reconstruction. Our aim was to evaluate the intra- and interrater reliability of an aesthetic outcome assessment scale with digital photos of breast reconstructions in two-dimensional (2D) and three-dimensional (3D) format. Thirty-three women with delayed breast reconstructions, consecutively participating in a five-year follow-up between November 2019 and June 2021, were included in the study. Of these, 14 were reconstructed with an expander prosthesis (EP) and 19 with a deep inferior epigastric perforator (DIEP) flap. Photos of the breasts were assessed in 2D and 3D format by expert, layman and patient panels. Data were analysed with the weighted kappa (wk) statistics. The intrarater agreements were moderate to substantial, with wk between 0.66 and 0.73 for the panels. Within the panels, the interrater agreements were 0.46–0.62. Moderate agreements were found between the matched 2D and 3D format photos (wk 0.62–0.66). The patient panel graded scar appearance worse in 3D compared with 2D format. In all panels, there was a tendency towards DIEP flap reconstructions receiving higher aesthetic outcome grades compared with EP. Thus, the aesthetic outcome assessment scale demonstrated acceptable agreements between the individual panellists and within the panels. Scars captured in 3D format may provide a greater resemblance to the reality compared with 2D. Implications for clinics remain to be further studied.

Assessment of local tissue water in breasts following breast reconstruction with an expander prosthesis or DIEP flap

The role of breast oedema in breast reconstruction is unknown. Therefore, our aim was to investigate local tissue water (LTW) and breast oedema-related symptoms in breasts reconstructed with either an expander prosthesis (EP) or with a deep inferior epigastric perforator (DIEP) flap at a minimum of one year postoperatively. Sixty-eight patients randomised to breast reconstruction with an EP or DIEP flap completed follow-up. Objective evaluation was performed at a mean of 25 (standard deviation, SD 9.5) months following breast reconstruction, and included measurements of breast volume and LTW with the MoistureMeterD® instrument. The patients completed the BREAST-Q questionnaire pre- and postoperatively. No significant differences in LTW were found when comparing EP and DIEP flap reconstructed breasts. The reconstructed breasts had an increase in LTW compared with the non-operated contralateral breasts. The BREAST-Q responses related to breast oedema symptoms were overall low and the median responses ranged from 1 to 2. A score of 1 indicated that symptoms were experienced ‘None of the time’. Our findings indicate that mastectomy followed by breast reconstruction inflicts damage on the lymphatic system, shown as an increase in LTW. However, no breast oedema-related symptoms were reported in the BREAST-Q questionnaire, and therefore, we consider our objective results to be below a potential threshold for symptomatic breast oedema. A threshold for clinical indication of breast oedema remains to be defined.

Breast softness in patients randomised to postmastectomy breast reconstruction with an expander prosthesis or DIEP flap

BackgroundObjectively measured breast softness in reconstructed breasts and its relation to patients’ subjective satisfaction with breast softness has not yet been investigated. The aim of this study was to evaluate breast softness in patients 1 year following delayed breast reconstruction with an expander prosthesis (EP) or deep inferior epigastric perforator (DIEP) flap, using objective and subjective methods.MethodsSeventy-three patients were randomised to breast reconstruction with an EP or DIEP flap between 2012 and 2018. Of these, 69 completed objective evaluation at a mean of 25 (standard deviation, SD 9.4) months following breast reconstruction. Objective evaluation included measurements of breast volume, jugulum-nipple distance, clavicular-submammary fold distance, ptosis and Baker scale grading. Breast softness was assessed with applanation tonometry. Subjective evaluation was performed using the BREAST-Q questionnaire.ResultsObjectively, DIEP flaps were significantly softer than EP breast reconstructions. Non-operated contralateral breasts were significantly softer compared with reconstructed breasts. In the subjective evaluation, the median score on the question (labelled 1.h) “How satisfied or dissatisfied have you been with the softness of your reconstructed breast (s)?” was higher in the DIEP flap group corresponding to greater satisfaction in this group. A fair correlation was found between the applanation tonometry and the patient-reported satisfaction with the reconstructed breast’s softness (rs = 0.37).ConclusionsIn terms of breast softness, breast reconstructions with DIEP flaps result in more satisfied patients. Concerning applanation tonometry as an objective tool for softness assessment, future studies on interobserver agreement are warranted.Level of evidence: Level I, therapeutic study

A short-term comparison of expander prosthesis and DIEP flap in breast reconstructions: A prospective randomized study

There is yet no clear consensus on which method is preferable in secondary breast reconstructions, prosthesis, or autologous tissue. In this first prospective randomized study, 29 women underwent reconstruction with expander prosthesis (EP) and 44 with deep inferior epigastric perforator (DIEP) flap. Inclusion started in 2012 and ended in 2018. Demographic data, complications, surgery time, hospital days, and consulting visits were recorded. Patient satisfaction was evaluated pre- and postoperatively using the BREAST-Q questionnaire. Health care costs were calculated based on rates from the financial year 2018. Here, we report the results related to the surgery and the first 30 postoperative days. The two groups were comparable regarding demographics and clinical characteristics. Satisfaction with breasts, measured with BREAST-Q, was significantly higher in patients who had undergone reconstruction with DIEP flap compared with EP. Within 30 days after breast reconstruction, significantly fewer women (n = 2) in the EP group suffered complications compared to the DIEP flap group (n = 16; p < 0.01). The health care cost was also significantly higher in the DIEP flap group relative to the EP group (p < 0.01). This patient cohort will be studied systematically over time, and results concerning the need for complementary surgery, costs, esthetics, and the patient-reported outcome (PRO) will be reported in future work. In this short-term report, EP seems to be preferable in regard to cost and complications, and DIEP flap is to choose from the patient's perspective.

Abstract P3-12-09: Dosimetric analysis of the pattern of local recurrence in breast cancer patients undergoing breast reconstruction and post-mastectomy radiotherapy

Abstract Background This study aims to identify spatial and dosimetric patterns of breast cancer relapse in a mono-institutional large series of patients treated with mastectomy and various forms of breast reconstruction. Material and Methods We retrospectively reviewed 196 patients with Stage II-III breast cancer treated with modified radical mastectomy between 1995 and 2016 at the Radiotherapy Department of Careggi Hospital, Florence. All patients performed Skin-sparing mastectomy or nipple-sparing mastectomy with immediate or delayed breast reconstruction and subsequently received post-mastectomy radiotherapy (PMRT). Systemic therapy was prescribed as per local and international guidelines both in neoadjuvant and adjuvant setting. All patients were treated with 3DCRT technique. Diagnostic imaging (e.g. CT, MRI) obtained at recurrence were registered with the original planning computed tomography (pCT) for the dosimetric analysis. Recurrence gross tumor volume (rGTV) were delineated and co-registered with pCT. All rGTV were compared dosimetrically to planned dose and spatially with planning target volumes. Locoregional recurrence (LR) were divided in three categories relative to the high dose region, 95% of prescription dose (D95%). We defined “in field LR” those with more than 90% of their volume within D95% region,“marginal LR” when recurrence volume was between 20 and 90% within D95% and “outfield LR” those with less than 20% of their volume D95%. Results The median age was 49 years (range, 26 - 83 years).163 women (83 %) were classified as stage III; 118 women (60 %) had more than three positive axillary nodes. The majority of lesions were estrogen receptor positive ( 75 %), grade 3 (52%) ,with the presence of LVI (60 %). Adjuvant RT at chest wall were performed in all patients, most of whom underwent a RT of chest wall +infra- supraclavicular nodes (71%).Prescribed RT dose was 50 Gy in 25 fractions. With a median follow-up of 60 months (range, 12-240 months), 22 (11%) patients experienced a locoregional relapse: 10 patients in the chest wall; 7 in ipsilateral axillary region +/- chest wall; 3 in internal mammary nodes -/+ chest wall; one locoregional relapse was observed in the supraclavicular nodes. Most of relapses were G3 (75%) with documented LVI (79%). The topographic analysis of the local failure patterns showed: thirteen (59 %) were “in-field LR”; 9 (41%) were “out-field LR” . For the spatial analysis, all relapses on the chest wall were observed above the breast tissue expander or mammary prosthesis. Free time from recurrence disease was 30 months (range 5-86 months). Conclusion This study suggests that chest wall recurrences are rare after PMRT and are related to biologic aggressiveness of the disease than to inadequate irradiation of target volumes. Prospective studies are warranted to evaluate the relationship between treatment volumes and patterns of recurrences in order to refine new delineation guidelines for women undergoing PMRT and breast reconstruction. Citation Format: Desideri I, Meattini I, Becherini C, Francolini G, Scotti V, Olmetto E, Perna M, Topulli J, Livi L. Dosimetric analysis of the pattern of local recurrence in breast cancer patients undergoing breast reconstruction and post-mastectomy radiotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-09.

Reply: Direct-to-Implant Breast Reconstruction without the Use of an Acellular Dermal Matrix Is Cost Effective and Oncologically Safe.

Sir: We thank Dr. Parisi and colleagues for their interesting response to our article.1 Conceptually, we completely agree that it is always better to have as much coverage of the implant as possible. In our practice, this is muscle, a deepithelialized dermal flap, or even potentially an acellular dermal matrix or mesh. This will provide potentially less rippling in the long term, as there is thicker coverage of the implant. However, it may not necessarily decrease the complication rates as far as sepsis and seroma are concerned, especially if an acellular dermal matrix or mesh is used. Coverage of the implant by whatever manner also does not necessarily change the perfusion of the mastectomy flaps, although tension in the repair may. Well established is the practice that unless an acellular dermal matrix or mesh is used, the surgeon is limited to using a skin-reducing mastectomy pattern with inferior deepithelialized dermocutaneous flap to cover the lower pole of the implant. If total muscular coverage is desired, a combination of the pectoralis major and the serratus anterior muscle is used. This will obviously limit the size of the prosthesis that can be placed in this relatively small pocket, as described in Dr. Parisi et al.’s letter. From a postoperative cosmetic point of view, in the lazy-S approach, the upper two-thirds of the implant is covered by the mastectomy flap and the pectoralis major muscle; thus, it is uncommon to have postoperative rippling in this area. If the lower mastectomy flap is very thin (<1 cm) then, not uncommonly, there will be some rippling in this area. This is usually corrected at the time of nipple-areola complex reconstruction with lipofilling of the lower mastectomy flap. It is also vital that the inframammary fold is retained during the mastectomy and that a tight snug pocket is reconstructed around the implant; otherwise, there is a high chance that the patient may end up with implant malposition or implant rotation. Mastectomy flap necrosis is one of the major concerns of which any breast reconstructive surgeon is acutely aware. The mastectomy needs to be performed in the mastectomy plane, and this can be vague; however, with appropriate traction on the skin and countertraction on the breast organ itself, the avascular white line can be seen and the mastectomy needs to be performed in this plane. If the mastectomy is performed in the correct plane, all that remains is the subcutaneous fat and the overlying skin. Although the patient’s body habitus often dictates the flap thickness, this is not always the case. The premise that the more weight the patient is carrying, generally the thicker the flap, cannot solely predict mastectomy flap. The blood supply to the mastectomy flaps after mastectomy is provided by the subdermal plexus, and if it is removed or damaged at the time of mastectomy, the surgeon should expect to have mastectomy flap necrosis. We do not routinely evaluate the mastectomy flap thickness before surgery and therefore there is no absolute number to use for the thickness of the mastectomy flap, as it varies from patient to patient. The most accurate way to determine perfusion and viability of the mastectomy flaps is to use intraoperative laser angiography [such as the SPY system (LifeCell Corp., Branchburg, N.J.)],2 which we do not use. If this is not available, débridement of the edges of the mastectomy flap will indicate the perfusion of that specific flap, and if there is doubt about the perfusion, the flaps can be trimmed back until the surgeon is happy with the perfusion. If there is not enough remaining skin to cover a large enough implant, the patient can then be converted to an expander prosthesis reconstructive pathway. Some patients are prone to wound healing problems, such as those with a high body mass index, diabetic patients, poorly controlled human immunodeficiency virus–positive patients, previously irradiated patients, and smokers. These women may have a higher postoperative complication rate in relation to wound healing and minor flap necrosis and should be approached and counseled with care. The reconstructive surgeon should have a much lower threshold to use an expander prosthesis reconstructive pathway for these high-risk patients. ACKNOWLEDGMENT The study received ethics approval from the Human Research Ethics Committee of the University of the Witwatersrand (M111121). DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. L. Charles J. Serrurier, F.C.S.Plast.Surg.(C.M.S.A.)Sarah Rayne, B.Sc.(U.C.L.), M.R.C.S.(Eng.), F.C.S.(S.A.)Marisse Venter, F.C.S.Plast.Surg.(C.M.S.A.)Carol-Ann Benn, F.C.S.(S.A.)University of the Witwatersrand and Milpark Breast Care Centre of ExcellenceJohannesburg, South Africa

A comparison of long-term cost and clinical outcomes between the two-stage sequence expander/prosthesis and autologous deep inferior epigastric flap methods for breast reconstruction in a public hospital

Postmastectomy breast reconstruction involves the use of large amounts of hospital resources. This study provides comparative data on the clinical results and long-term economic costs of two methods of breast reconstruction in a public hospital. A prospective cohort study was performed to evaluate the costs incurred by delayed unilateral breast reconstruction performed using either the two-stage sequence expander/prosthesis (E-P) or autologous deep inferior epigastric flap (DIEP) method during 2005-2013 in 134 patients. The major evaluated variables included previous clinical records, history of radiotherapy, and number of surgical procedures. Total costs accounted for both direct intra- and extra-hospital costs derived from the initial reconstruction and those resulting from associated reoperations due to aesthetic retouches and/or complications. Patients undergoing E-P reconstruction required a higher number of surgery sessions to complete the reconstruction (3.07 vs. 2.32, p < 0.001) and showed higher rates of surgery-related complications (40.29% vs. 32.82%). No statistically significant differences were found between the two surgical methods in terms of total costs (€18857.77 DIEP vs. €20502.08 E-P; p = 0.89). In the E-P cohort, active smoking and history of radiotherapy were statistically significant risk factors of complications. In the DIEP group, only active smoking was significantly associated with complications. Compared to the E-P method, breast reconstruction using the DIEP method is more cost-effective and involves fewer serious complications that result in reconstruction failure or undesirable aesthetic results. E-P reconstruction presents a higher number of complications that may cause surgical failure or poor outcomes.

Breast reconstruction with an expander prosthesis following mastectomy does not cause additional persistent pain: A nationwide cross-sectional study

Few studies have examined the prevalence of persistent pain after breast reconstruction with an implant after tissue expansion in comparison to mastectomy without breast reconstruction. Our primary objective was to evaluate the prevalence of persistent pain after breast reconstruction with a subpectoral implant after tissue expansion in a population-based study. Secondary objectives were to evaluate sensory disturbances, lymphoedema and functional impairment. This was a nationwide cross-sectional questionnaire study of breast cancer patients aged 18-69 years who were treated with or without reconstruction after mastectomy for primary breast cancer in Denmark between 1 January 2005 and 31 December 2006. The response rate was 84% for mastectomy without reconstruction and 83% for patients treated with breast reconstruction. A total of 129 patients treated with mastectomy and breast reconstruction with a subpectoral implant were compared with 1131 patients treated with mastectomy without reconstruction. Prevalence of persistent pain for patients treated with mastectomy followed by reconstruction with an implant was 40% compared to 48% of patients treated only with mastectomy. We found no increased risk of persistent pain in patients having a reconstruction with an implant compared with mastectomy without reconstruction (odds ratio (OR) 0.82, 95% confidence interval (CI) 0.55-1.22, P=0.33) when adjusting for age, axillary procedure, radiotherapy and chemotherapy. We observed no difference in the prevalence of pain between patients treated with immediate or delayed breast reconstruction (P=0.116). Breast reconstruction with a subpectoral implant after tissue expansion does not confer increased prevalence of persistent pain.

À propos de deux cas de lymphome mammaire sur coque périprothétique : un diagnostic difficile ; une pathologie méconnue

The anaplastic large cell lymphoma (ALCL) is a rare disease, its incidence in the United States is one case per 500,000 women and three for 100 million patients for breast single location. Forty-six cases have been reported in the literature. They can grow on any type of implant: expander prosthesis silicone and saline, smooth or textured envelope. Currently, the consensus process includes capsulectomy, removal of the implant, chemotherapy and radiotherapy. However, some authors classify under indolent disease, but we believe that some cases may escape any therapeutic and become very aggressive forms. It is therefore important to make an early diagnosis and start treatment urgently. Severity and suspicion of iatrogenic nature of ALCL have an obligation to inform future with implants.

A new method for using a silicone rod for permanent nipple projection after breast reconstruction procedures

Nipple–areola complex (NAC) is a unique part of the human body. Not only is it a functional structure, but it plays an aesthetic role as well. It offers the final touch to the convex shape of the breast. Its lack frequently leads to depression in patients. This paper describes the method used by the authors for reconstructing nipple mound projection in patients following an autologous breast reconstruction procedure. To reconstruct the nipple mound an adapted local C-V flap technique described by Losken was used, with a silicone rod to support the nipple. The new method is based on simple preparation of flaps, fixing the silicone rod at the nipple bottom and below the top, it is quick and efficient in terms of time and materials used. The procedure was conducted in 30 patients: 10 cases following LDf reconstruction and Becker prosthesis or expander prosthesis, 20 cases following body tissue reconstruction with TRAM flap (Transverse Rectus Abdominis Musculocutaneous flap). All the patients who had undergone the LDf procedure developed flap necrosis followed by rod removal. In the patients who had undergone TRAM flap reconstruction no necrosis or wound split was observed, healing progressed without complications. In this group durable nipple projection was achieved. The new method for reconstructing nipple projection may be applied both in simultaneous and staged procedures, only in patients who have undergone autologous breast reconstruction procedure.

Delayed Development of Toxic Shock Syndrome Following Abdominal Tissue Expansion in a Pediatric Reconstruction Patient

Toxic shock syndrome (TSS) is a potentially fatal postoperative complication, and even more so if the diagnosis is delayed. We present the case of a 7-month-old male infant who developed TSS as a complication of tissue expansion using an external port device. There have been 5 documented cases of TSS after tissue expander or breast prosthesis placement occurring in the adult population, however, there has not been a reported case of TSS in an infant. The long interval to development of TSS like symptoms, 4 months in this case, should not exclude TSS from the differential diagnosis. In a pediatric patient, a diffuse macular rash without the severe systemic symptoms on initial presentation can present as a diagnostic challenge. New diagnosis techniques are discussed that can shorten the time to a diagnosis of TSS. In this case, because the local bacterial count was low, the expanded tissue was transferred without complication.

Bronchial Obstruction after Pneumonectomy

A 42-year-old woman underwent right pneumonectomy because of extensive parenchymal destruction due to tuberculosis. Five years after resection, she reported increasing shortness of breath, wheezing, and dyspnea on exertion. A computed tomographic scan of the chest revealed counterclockwise rotation of the mediastinum, with mediastinal shift and compression of the left-lower-lobe bronchus (LLLB) between the pulmonary artery and aorta (Panel A, arrow), features consistent with the post-pneumonectomy syndrome. Mediastinal repositioning was accomplished with the use of an intrapleural-tissue expander and saline-filled prosthesis. Panel B shows a patent left-lower-lobe bronchus (asterisk) and the saline-filled prosthesis in the right side of the chest . . .

The use of expander and breast implant for reconstruction after mastectomy

In our tertiary Plastic surgery unit the number of breast reconstruction patients is rapidly increasing due to better patient education provided by general practitioners, oncologist surgeons and enhanced media coverage. The yet unfinished trend presents us with a high volume of cases seen at a joint meeting of oncology and reconstruction surgeons where treatment options in terms of reconstruction are discussed. We have noticed that more and more patients have rather firm inclination towards certain type of reconstruction, many decidable decline free tissue transfer. We usually inform the patient on other treatment options but try to endorse their original decision when clinically sound. Along with cases not feasible for autologous reconstruction (unsuitable donor area, inconvenient general condition) the proportion of reconstruction with expander and breast implant versus autologous reconstruction is approximately 60 percent. We present our experience with expanders McGhan style 133 and expander prosthesis style 150.

Brustrekonstruktion mit Becker-Expandern allein und in Kombination mit Latissimuslappen

BACKGROUND: The Becker permanent tissue expander for breast reconstruction was designed in order to achieve a more natural form of the breast by overexpansion followed by controlled deflation especially if combined with a latissimus flap. The present study was done in order to confirm this in our cases of breast reconstruction. METHODS: Between July 2003 and May 2007 in 43 breasts in 34 women an expander prosthesis was implanted, in 19 breasts in combination with a latissimus dorsi flap. In the same period the latissimus dorsi flap was used to cover a prosthesis of fixed volume in 9 cases. The anatomically shaped Becker 35 expander was implanted in 10 breasts in 6 women. Patients were examined physically after a median follow-up of 30 months. RESULTS: A generally low complication rate was seen after all kinds of reconstruction with Becker expanders. The breasts which were reconstructed by latissimus flaps and expanders exhibited larger breast volumes but only a slight increase in ptosis than the breasts after reconstruction by a latissimus and a prosthesis of fixed volume. CONCLUSIONS: The use of prostheses for breast reconstruction, alone or in combination with a latissimus flap is still a valuable method. According to our findings, a Becker expander should be suggested to be implanted under the latissimus flap, if the final volume of the prosthesis will be more than 300 cm3.

Long-Term Sensibility Following Nonautologous, Immediate Breast Reconstruction

Immediate breast reconstruction after mastectomy, using submuscular expander prostheses, is well established in the treatment of breast cancer. The aim of this study was to survey the postoperative cutaneous somatosensory status and to analyze the patients' subjective opinion about the sensibility in the reconstructed breast. Fourteen patients were included and examined 3-6 years after reconstruction. The untreated contralateral breast served as control. None of the patients had received any locoregional radiotherapy. The perception thresholds to touch, cold, warmth, and heat pain were assessed and a questionnaire about the patients' subjective experience of sensibility was completed. In the quantitative somatosensory testing, statistically significant impairment concerning all the examined modalities was demonstrated. The least affected was the heat pain modality. In the questionnaire, the patients reported weaker nonmodality specific sensibility from the reconstructed breast compared with the control breast. More than half of the patients reported that the reconstructed breast felt like a real breast. In conclusion, the study revealed long-term, overall sensibility impairment following nonautologous, immediate breast reconstruction.

Rupture of an expander prosthesis mimics axillary cancer recurrence

Regional silicone gel migration from a ruptured breast implant has been reported at different locations including the upper extremity, chest wall muscles, axilla and back. We report a patient who presented with an axillary mass that mimicked a regional recurrence 5 years after breast cancer reconstruction with a latissimus dorsi musculocutaneous flap and silicon gel expander-prosthesis. Surgical exploration revealed that the mass contained silicone gel around the port of the breast expander that had ruptured. The mass was confluent with an intracapsular silicone leak through a tract along the tube of the expander port.

Technical aspects of immediate breast reconstruction with implants: Five year follow-up

We describe the technical aspects of 249 patients who had immediate breast reconstruction with implants and a follow-up of at least five years. The type of reconstruction was permanent expander prostheses (n=208), permanent prostheses (n=32), and temporary expander prostheses (n=9). The median total number of operations required to complete the reconstruction was 3 (range 1-6) with nipple-reconstruction included. Thirty-two patients developed local complications (13%) and three had systemic complications (1%). Eighteen implants were lost, so the failure rate of reconstruction was 7%. The technique of immediate breast reconstruction with implants is associated with a low overall morbidity. This, combined with earlier reported psychological advantages, no increased risk of cancer relapse, and reasonable cost, indicates the importance of immediate reconstruction with implants in the treatment of breast cancer.

Salvage of infected expander prostheses in breast reconstruction.

Periprosthetic infection is a devastating complication following breast reconstruction with prostheses. Traditional surgical principles dictate removal of the prosthesis to control infection. Although successful salvage of prostheses in the presence of periprosthetic infections has been reported in the plastic and other surgical literature, salvage procedures remain seldom practiced. Reports in the plastic surgery literature have been limited to implant salvage following cosmetic breast augmentation and subcutaneous mastectomy with implants. Salvage of saline-filled expander prostheses used in breast reconstruction following mastectomy for cancer has not been previously reported. The authors review their experience with implant salvage in patients with periprosthetic infections following breast reconstruction for a 6-year period. Fourteen patients (13 with saline-filled expander prostheses and one with silicone prosthesis) underwent implant salvage. Salvage of the breast reconstruction was successful in nine patients. Staphylococcus aureus infection was associated with poorer salvage rate (p = 0.023). Previous radiotherapy to the chest wall did not affect the salvage outcome (p = 0.50). In selected patients, immediate salvage of a breast reconstruction in the presence of prosthesis-related infection remains an alternative to implant removal followed by delayed reconstruction.