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Staged breast reconstruction with tissue expander removal

Breast reconstruction with tissue expanders and implants offers patients satisfying aesthetic results with no donor site morbidity. Implant breast reconstruction is generally best performed as a two-stage procedure. Although satisfactory results can be obtained with single-stage surgery, for most patients a more reliable approach involves removal of the expander and placement of the permanent device as a second operation. This second stage allows for precise positioning of the inframammary fold; capsulotomy to release soft tissue, thus increasing breast projection and ptosis; and reevaluation of breast height and width to achieve maximal symmetry with the contralateral breast.

Selection of the optimal tissue expander requires careful assessment of the breast dimensions. In general, an expander should be selected that accurately matches breast width. The height of the device may exceed that of the contralateral breast to permit full expansion of the breast skin flaps. The potential volume of the expander should equal or slightly exceed the estimated breast volume. In the setting of a delayed reconstruction, a review of the previous mastectomy weight/volume may be helpful as an estimate of the contralateral breast volume.