Immediate breast reconstruction with prolonged overexpansion using the Becker permanent expander prosthesis

Summary Immediate breast reconstruction following modified radical mastectomy for breast carcinoma will be described. The method which is favored is an insertion of a Becker permanent expander prosthesis. This is overexpanded and left in this situation for 6 months if possible. It is then deflated and the filling valve is left for another month to carry out further adjustments as necessary. Ninety-six patients with 146 implants with an average follow-up of 3.2 years have been reviewed. The vast majority of patients have been satisfied with their results and the plastic surgeon has also been pleased and has judged this to be the best method for reconstruction available at this time. There have been complications of cellulitis, implant exposure, capsule formation, silicone and fluid leaks, but these have not been unduly significant when compared with the total number of implants inserted.     

Immediate breast reconstruction with expander in pregnant breast cancer patients

BackgroundBreast reconstruction after mastectomy is currently considered an essential component in managing breast cancer patients, particularly those diagnosed at a young age. However, no studies have been published on the feasibility of immediate breast reconstruction in patients diagnosed and operated during the course of gestation.MethodWe retrospectively identified all breast cancer patients who were subjected to mastectomy and immediate breast reconstruction during pregnancy at the European Institute of Oncology between 2002 and 2012. Patient demographics, gestational age at surgery, tumor stage, adjuvant treatment, details of the surgical procedures, surgical outcomes and fetal outcomes were analyzed.ResultsA total of 78 patients with breast cancer diagnosed during pregnancy were subjected to a surgical procedure during the course of gestation. Twenty-two patients had mastectomy; of whom 13 were subjected to immediate breast reconstruction. Twelve out of 13 patients had a two-stage procedure with tissue expander insertion. Median gestational age at surgery was 16 weeks. No major surgical complications were encountered. Only one patient elected to have an abortion, otherwise, no spontaneous abortions or pregnancy complications were reported. Median gestational age at delivery was 35 weeks (range: 32–40 weeks). No major congenital malformations were reported. At a median follow-up of 32 months, all patients are alive with no long-term surgical complications.ConclusionsThis is the first study of immediate breast reconstruction in pregnant breast cancer patients. Tissue expander insertion appears to ensure a short operative time, and does not seem to be associated with considerable morbidity to the patient or the fetus. Hence, it could be considered in the multidisciplinary management of women diagnosed with breast cancer during pregnancy.     

Post-mastectomy breast reconstruction using the inflatable tissue expander

Breast reconstruction following mastectomy has previously relied on the insertion of a silicone gel implant or the use of a myocutaneous flap. We report the use of an innovation, the inflatable tissue expander, for both immediate and delayed breast reconstruction in 26 patients where soft tissue cover was inadequate to permit the use of the silicone implant. By serial inflation of the tissue expander with saline, sufficient tissue cover was achieved for a second operative placement of a silicone prosthesis of appropriate volume to match the normal breast. To date, 10 patients undergoing delayed reconstruction and 5 of 16 patients with immediate reconstruction have had their final prosthesis inserted, while 3 women are satisfied with the result of the expandable implant and desire no further surgery. Only two technical complications have arisen with loss of the expander in one patient who had had recent radiotherapy and in another the tissue expander was placed much too high on the chest wall. Mechanical failure occurred in three cases where disruption of the seam led to sudden deflation in two and a slow leak from the injection port developed in one. One patient also attempted self-inflation leading to deflation of the tissue expander. The cosmetic results were subjectively and objectively very good with capsular distortion present in only one case. We feel that the inflatable tissue expander is simple and safe to use, may be used for immediate reconstruction without compromising the ablative surgery and should be a choice available to general surgeons for providing safe and cosmetically acceptable reconstructive surgery.     

Immediate autologous latissimus breast reconstruction after skin sparing mastectomy

A technique of immediate breast reconstruction, combining skin sparing mastectomy and autologous latissimus breast reconstruction, is presented. In this study, 50 patients underwent this procedure between May 1993 and May 1997. The most frequent indication (62%) was ductal carcinoma in situ (multifocal, high grade or larger than 3 cm). In 38% of cases, the patients had a contraindication to the TRAM flap; in the other cases (62%) the patients preferred the dorsal donor site to the abdominal site. Reduction of the contralateral breast was done in 20% of cases of unilateral reconstruction. The aesthetic results, evaluated by two others surgeons, were rated as very good in 88% of cases, good in 8% and poor in 4%. Study of patient satisfaction showed 84% of patients to be pleased, 12% satisfied and 4% poorly satisfied. Dorsal sequelae were rated as slight in 96% of cases, intermediate in 4% and marked in none. The main disadvantage was dorsal seroma which occurred in 62% of cases but was easily managed by repeated aspiration. No patient developed a local recurrence or distant metastases. This technique represents a significant advance in breast reconstruction, giving a breast of natural shape and consistency with no transverse scar or patch effect due to the flap. Received: 13 October 1997 / Accepted: 16 November 1998     

Primary breast reconstruction with a subpectoral silicone tissue expander

A Silastic tissue expander inserted subpectorally at the time of modified radical mastectomy has provided early development of the reconstructive envelope, thereby simplifying matching of the contralateral breast. Significant emotional support for the woman faced with imminent loss of her breast has been repeatedly observed. The early interaction of general and plastic surgeons in the management of breast cancer has been found to be beneficial to both patients and physicians.     

Primary and secondary breast reconstruction with a permanent expander

Summary The second generation of tissue expanding prostheses is the permanent expander. It has been used in a series of 88 breast reconstructions following mastectomy for malignant and premalignant disease in 49 secondary and 39 primary reconstructions, the longest follow-up being 45 months and the shortest 12 months. Pre- and postoperative radiotherapy (45 gy) has been the major source of complications: implant loss (11%), infection (2%); capsular contracture-Baker's grade III–IV (90%); and, improper positioning should also be mentioned. Primary reconstruction is no longer performed if postoperative radiotherapy is scheduled. The results were totally different if radiotherapy was omitted after primary reconstruction. The expansion was smooth, an attractive breast shape with mild ptosis was easily achieved, and only minor complications were encountered. A permanent tissue expander, either alone or covered with a latissimus dorsi flap, remains our first choice in breast reconstruction.     

Immediate breast reconstruction: results and satisfaction

Delayed breast reconstruction following mastectomy for cancer is widely accepted because of a high satisfaction rate. Immediate breast reconstruction offers an even more satisfactory solution, especially related to recovery and self-esteem. In our study, immediate breast reconstruction was performed for three indications: breast cancer, high risk for development of breast cancer and chronic cystic breast disease. Forty-eight consecutive patients with a mean age of 48 years were evaluated. In 37 cases malignant disease, in eight patients prophylaxis, and in three patients benign disease were the reasons for mastectomy. In 42 patients, primary reconstruction was performed, using tissue expanders, followed by prosthetic replacement. Of the other six patients, three were reconstructed with a definitive prosthesis and three with a musculocutaneous flap. At the end of the follow-up period, 42 patients had a definitive prosthesis and two patients had their breasts reconstructed with autologous tissue only. Four patients stopped the procedure following infection and extrusion of their implants. These infections accounted for an overall complication rate of 24%. After starting perioperative antibiotic prophylaxis from the 20th patient onwards, the complication rate was reduced to 12%. Thirty-three patients could be interviewed to assess satisfaction: nine patients were very satisfied, 18 were satisfied and six were moderately satisfied with the end result. Thus, 82% of the patients were satisfied. Received: 30 December 1999 / Accepted: 3 February 2000     

背阔肌肌瓣在双侧乳腺皮下切除后即时隆乳六例

目的：探讨双侧乳腺重度增生时,既能彻底切除,防止癌变,又能保持乳房外形的术式。方法：经腋下沿腋后线切口,行双侧乳腺皮下切除术,用带神经血管蒂的背阔肌肌瓣移转即时行隆乳。结果：1995－1998年治疗6例,术后双侧乳房对称,外形美观,手感良好。结论：该术式操作简便易行,切口隐蔽,组织瓣量大,血供好,外形美观,供区无明显后遗畸形,不影响功能。     

保留乳头乳晕乳腺全切除术后Ⅰ期假体植入10例报告

目的探讨保留乳头乳晕的乳腺全切除术后Ⅰ期乳房重建的适应证、方法、效果及可行性。方法东南大学附属中大医院2009年1月到2010年10月对10例病人行保留乳头乳晕的乳腺全切术及Ⅰ期假体植入的乳房重建术,术后从客观和主观两个角度评价美容效果,观察其并发症及随访治疗效果。结果所有病人手术成功。术后早期,2例出现轻微并发症,予以对症治疗后痊愈。术后随访6～18个月,主、客观评价的优良率均为100%。其中7例乳腺癌病人局部无复发,远处无转移。结论保留乳头乳晕的乳腺全切术后Ⅰ期乳房重建术的手术操作简单易行,美容效果好,无严重并发症,且不影响乳腺疾病的治疗。     

TRAM flap breast reconstruction using a fascia-sparing technique]

Although the TRAM flap has been accepted as one of the most common methods for breast reconstruction utilizing the autologous tissue, its disadvantage is that scarring of the abdominal sheath and muscle may result in postoperative abdominal bulge or hernia. To solve this problem, the authors developed the fascia-sparing technique in TRAM flap breast reconstruction. The technique, in which most of the anterior rectus sheath is preserved, has been applied in 3 patients after radical mastectomy and 7 patients after modified radical mastectomy. With an average follow-up period of 1 year and 2 months, no abdominal bulge or hernia was noted in any patient without the use of prosthetic mesh for the abdominal closure. This fascia sparing technique is particularly effective for TRAM flap reconstruction requiring bilateral rectus abdominis muscle portions and containing only a few minor perforators, for which a DIEP flap is not suitable.     

Natural skin reduction and breast recovery using a tissue expander after enucleation of a giant breast tumour.

We report a new use of the tissue expander for reshaping a breast after resection of a giant tumour. After resection of giant fibroadenomas, two patients had expanders inserted into the tissue defect and gradually reduced in size over five months. This facilitated healing and natural skin shrinkage and resulted in a natural shape and size.     

Immediate breast reconstruction in two stages using anatomical tissue expansion.

Over the last four years, 43 modified radical mastectomies and 13 simple mastectomies were done for 56 patients with breast cancer followed by immediate reconstruction in two stages using anatomical tissue expansion. In 49 patients a permanent prosthesis was successfully implanted while three patients 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 further attempts were made to reconstruct the breast. All 10 patients given radiotherapy 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 patient satisfaction 7.8 on a 0-10 scale. We concluded that immediate breast reconstruction with anatomical tissue expansion gives predictable aesthetic results, 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 be candidates for this procedure.