Technique of immediate reconstruction with tissue expanders after mastectomy for breast cancer

Abstract

Tissue expanders are regarded as a simple method for immediate breast reconstruction following mastectomy. However, to achieve a satisfying cosmetic result and avoid complications associated with the procedure several technical aspects and a careful selection of patients is required. Early ccomplications of tissue expansion are skin necrosis with wound dehiscence and implant extrusion. In case the viability of the skin flaps is in doubt the expansion process should be delayed and any nonviable tissue should be excised early to allow secondary wound healing. The expansion is started no earlier than wound healing is completed, and viability of mastectomy flaps is secured. Complete muscular coverage of the expander reduces the risk for expander extrusion in case of wound infection or wound dehiscence. In case of ptosis of the contralateral breast overexpansion is needed to get an acceptable ptosis. If necessary, the mobilisation of the lower part can be extended downwards to the rectus sheath to gain an excess amount of skin which is used to create a submammary fold. When the expansion is finished the excess amount of skin is fixed to the muscle fascia. Another possibility is to overexpand and exchange the expander to a slightly smaller implant. It is mandatory to leave the suction drains until drainage is less than 20cc for 2 consecutive days. This avoids seromas which are related to a higher risk for capsular fibrosis.