Journal of Aesthetic & Reconstructive Surgery

Skin Sparing/Reducing Mastectomy, Expander/Implant-Based Breast Reconstruction and Timing of Inflation Initiation

Expander/implant-based breast reconstruction is currently the most commonly performed breast reconstruction technique. Most of these reconstructions are a two-stage process. After insertion of a tissue expander it is conventionally recommended to wait 10-14 days postoperatively before initiation of expansion that will usually require 6-8 weeks for completion. However, with immediate reconstruction following skin sparing/reducing mastectomy (SSM/SRM), these recommendations for initiation and rate of expansion may be questionable. Whenever ample skin flaps are enough to provide proper skin envelope for the reconstructed breast, the limiting factor to expansion initiation is the assurance of good skin flaps vascularity in the immediate post-operative period. This is usually clinically obvious, within 2-3 days at which time expansion can be initiated safely and may be completed quickly in a short time. Restoring breast mound as soon as possible minimizes post-mastectomy disfigurement and associated psychological burden.
We present our experience with one stage breast reconstruction with early and rapid expansion of Becker permanent expanders. We feel that with this expansion approach, the two-stage procedure may not be necessary; instead, one stage reconstruction with a permanent Becker expander/implant is possible and can have an aesthetically pleasing outcome.

Author(s):

Bishara Atiyeh, Fadel Chahine, Nazareth Papazian and Hamed Janom

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