Abstract
Background:
Congenital breast asymmetry can have significant adverse psychosocial sequelae for adolescent and young adult women. Although early surgical intervention is beneficial, commonly described techniques include immediate implant and autologous tissue transfer reconstruction. We describe and evaluate outcomes of our 22-year experience using tissue expanders before implant placement to maintain symmetry throughout breast development.
Methods:
A retrospective chart review analyzed patients with congenital breast asymmetry who completed 2-stage breast reconstruction from January 2000 to November 2022. Patients’ demographic, clinical, surgical, and complication data are reported.
Results:
Thirty patients completed 2-stage breast reconstruction for congenital breast asymmetry. The most common diagnosis was Poland syndrome. Median age at initial presentation was 17 years. About 47% of patients received tissue expanders before 18 years of age, and 30% of patients received implants before 18 years of age. The median interval between tissue expander placement and implant placement was 351.5 days, with a median interval of 223 days between final tissue expander fill and implant placement. Median follow-up time after implant placement was 731.5 days. Adjunctive procedures were performed in 87% of patients and included contralateral mastopexy, contralateral augmentation, fat grafting, ipsilateral latissimus dorsi flap, and free nipple grafting. Major and minor complication rates were 27% and 43%, respectively.
Conclusions:
Two-stage breast reconstruction with tissue expansion is a viable option for patients with congenital breast asymmetry of various phenotypes. Complication rates were similar to those of other forms of breast reconstruction. Through serial expansion, this technique enables maintenance of breast symmetry throughout development.
Takeaways
Question: Is 2-stage breast reconstruction with tissue expanders a feasible option for patients with congenital breast asymmetry?
Findings: This retrospective study shows that 2-stage reconstruction with tissue expanders is a reliable approach for adolescent and young adult women with congenital breast asymmetry across a wide range of phenotypes, with complication rates similar to those of other techniques.
Meaning: Over 22 years, we found that tissue expanders allow gradual adjustment of the affected breast, accommodating the natural development of the contralateral breast until final reconstruction with a permanent implant is appropriate.
INTRODUCTION
Congenital breast asymmetry represents a spectrum of developmental breast anomalies that can lead to long-term psychosocial distress, particularly in adolescent and young adult (AYA) women. Breast development serves not only as a physiological milestone but also as a social marker symbolizing the transition from adolescence to adulthood. During this critical period, AYA women are particularly susceptible to low self-esteem, body image dissatisfaction, and heightened sensitivity to peer and societal expectations.1,2 Congenital breast asymmetry is a condition that can play a significant role in long-term psychological distress in AYA patients, especially as the asymmetry worsens due to disproportionate contralateral breast growth.1,2 It includes a range of phenotypes such as Poland syndrome, tuberous breast deformity, and breast hypoplasia.3–5 Each form of congenital breast asymmetry comes with its own unique reconstructive challenges due to its broad anatomical variations.
Prior studies have suggested that surgical intervention can improve the quality of life for AYA women with congenital breast abnormalities to levels similar to those of peers with no breast abnormalities.1 Most commonly described techniques include immediate implant or autologous tissue transfer reconstruction.4–9 These techniques have limited flexibility, preventing AYA patients from adjusting the size of their reconstructed breast to match their contralateral breast, which may continue to develop during puberty or into early adulthood. One potential solution for this patient population is initial treatment with tissue expanders.10 This reconstructive technique allows patients to gradually increase the size of the affected breast to match the contralateral, unaffected breast as it continues to develop. Despite its conceptual benefits, the use of tissue expanders as part of a 2-stage reconstruction strategy in this patient population remains underdiscussed in the literature, and previous literature on oncological reconstruction has recommended restricting tissue expander placement to a 1-year duration.11 This technique may also be especially useful for AYA patients with severe breast hypoplasia, for whom the congenitally deficient breast skin envelope cannot accommodate a definitive implant at the outset.6,10 The use of tissue expanders permits tailored size control throughout development and helps refine implant selection. To date, however, there are limited data specifically evaluating outcomes, complications, and overall feasibility of this method in AYA patients with varying etiologies of congenital breast asymmetry.
In this context, we performed a retrospective chart review to demonstrate the feasibility of 2-stage breast reconstruction using tissue expanders for AYA patients with congenital breast asymmetry of various etiologies. We describe the surgical pathway, expand upon our clinical experience, and analyze postoperative complications to assess the utility of this technique for achieving breast symmetry in this patient population.
METHODS
Study Design and Data Source
A retrospective review was performed of patients who underwent 2-stage breast reconstruction for congenital breast asymmetry at a single institution. Using our institution’s DataDirect software (DataDirect, University of Michigan, Ann Arbor, MI), patients who underwent breast reconstruction with tissue expanders from January 1, 2000 to November 30, 2022 were identified. This study expands on the work of Oakes et al10 by extending the study period to include data from 2006 to 2022. This study was determined to be exempt by the institutional review board (HUM 00191952). This study was conducted and reported in accordance with the STROBE guidelines.12
Cohort Selection
Patients were identified using billing codes used for tissue expander placement in breast reconstruction (CPT codes 19357, 19357.1, 19357.C1). Inclusion criteria for chart review included the following: (1) a birth date after January 1, 1980; (2) female sex; and (3) patients who underwent tissue expander placement for congenital breast asymmetry (eg, Poland syndrome) as opposed to acquired breast disorders (eg, breast cancer status post mastectomy). Exclusion criteria for analysis included patients who had not completed the entire reconstructive process at the time of chart review. Sample size was based on the volume of patients undergoing 2-stage breast reconstruction for congenital breast asymmetry at the institution from January 2000 to November 2022.
Surgical Procedure
The choice between 2-stage tissue expander reconstruction and single-stage implant placement was determined preoperatively by the maturation stage of the contralateral breast, as well as the adequacy of the skin envelope (Fig. 1). If the contralateral breast had not yet achieved stable maturity, a 2-stage tissue expander reconstruction was performed. In these cases, the tissue expander was left in place and intermittently filled to match symmetry between the hypoplastic, reconstructed breast and the gradually maturing contralateral breast, remaining until the contralateral breast size was stable for at least 6 months. Alternatively, if the contralateral breast had achieved stable maturity, we generally performed a single-stage procedure with implant placement. In cases where the skin envelope was not large enough to support a single-stage reconstruction, a tissue expander was used as part of a 2-stage procedure.
Fig. 1.
Preoperative photographs of a patient with left-sided severe Poland syndrome before breast reconstruction. A, Frontal view, arms down. B, Frontal view, arms up. C, Oblique view. The patient had previously undergone left axillary and medial arm scar contracture release.
For the 2-stage reconstructions presented in this study, the first stage of the operation involved placement of a round tissue expander with an integrated port. The tissue expander was placed either through an inframammary fold incision or an endoscopically assisted transaxillary approach. For patients with an intact pectoralis major, the tissue expander was placed in the subpectoral plane. For patients with an absent pectoralis major, the tissue expander was placed in the subglandular plane. Acellular dermal matrices were not used. The tissue expander was filled to match the size of the contralateral breast or to the maximum volume allowed by the breast pocket. The tissue expander was left in place and intermittently filled to match symmetry between the hypoplastic, reconstructed breast and the gradually maturing contralateral breast. The tissue expander was left in place until contralateral breast maturation and stabilization, defined as at least 6 months of stable size, and until the congenitally deficient breast skin envelope could accommodate a definitive implant (Figs. 2, 3).
Fig. 2.
Postoperative photographs of a patient with Poland syndrome after stage I breast reconstruction with a left tissue expander and subsequent expansion. A, Frontal view. B, Oblique view. The patient also underwent a modified Ravitch procedure by pediatric surgery at the time of her tissue expander placement to address her pectus deformity.
Fig. 3.
Postoperative photographs of a patient with Poland syndrome after stage I breast reconstruction with a left tissue expander demonstrating continued contralateral breast growth and serial expansion. A, Frontal view. B, Oblique view. This patient was the only patient in our sample who required upsizing of her original tissue expander due to contralateral breast growth beyond the size of the original tissue expander.
At the second stage of the operation, the tissue expander in the reconstructed breast was removed and replaced with a permanent implant to match the contralateral unaffected breast size. Occasionally, to ensure optimal symmetry and achieve patient aesthetic goals, the surgeon would perform a contralateral mastopexy, contralateral augmentation, and/or an ipsilateral endoscopically harvested latissimus dorsi muscle transfer for chest wall and anterior axillary fold reconstruction (Fig. 4). Autogenous fat grafting and ipsilateral free nipple grafting were also occasionally performed at various time points to optimize cosmesis (Fig. 5).
Fig. 4.
Postoperative photographs of a patient with Poland syndrome after stage II breast reconstruction with exchange of her left tissue expander for a 550 cm3 silicone breast implant, left anterior chest reconstruction with an ipsilateral endoscopic left pedicled latissimus dorsi flap, and contralateral right breast mastopexy. A, Frontal view. B, Oblique view.
Fig. 5.
Postoperative photographs of a patient with Poland syndrome after left nipple–areolar complex free nipple grafting for nipple repositioning and 60 cm3 of autogenous fat grafting to the left superior breast. A, Frontal view. B, Oblique view.
Outcomes
Electronic health record review of each patient was completed by 2 study team members (A.E.H. and I.E.). Demographic information included age at the time of presentation, age at the time of tissue expander placement, age at the time of implant placement, and race. Clinical information included diagnosis, body mass index, tobacco use, unilateral or bilateral tissue expander/implant placement, nipple position, and presence of the pectoralis major muscle. Tissue expander surgical information included the date of tissue expander placement; the incision through which the tissue expander was placed; the size of the tissue expander used; the intraoperative fill volume; the number of in-clinic tissue expander fills; and the final tissue expander fill volume. Breast implant surgical information included the date of implant placement; the interval between tissue expander surgery and implant surgery; the interval between tissue expander final fill and implant surgery; the implant size; whether and when fat grafting was performed; whether contralateral mastopexy, contralateral augmentation, or an ipsilateral muscle flap was performed; and the follow-up time between the date of implant surgery and the most recent appointment. Complications, both intraoperative and postoperative, following either stage of surgery, and elective revisions were also documented. Major complications were defined as complications that required urgent/emergent reoperation, readmission, or tissue expander failure/removal, whereas minor complications were defined as complications that were managed in the outpatient setting and nonoperatively.13
Statistical Analysis
The primary goal of this study was to describe the process and outcomes of 2-stage breast reconstruction for congenital breast asymmetry, with particular attention to associated complications, using descriptive analysis. Categorical variables are presented as counts and percentages, whereas continuous variables are reported as medians with interquartile ranges (IQRs) and ranges. All statistical analyses were performed using Stata software (StataCorp, College Station, TX).
RESULTS
A total of 32 patients underwent tissue expander placement for congenital breast asymmetry during the study period. Two patients had not yet completed the second stage of the 2-stage breast reconstruction at the time of analysis and were excluded, leaving 30 patients for final analysis.
Demographic and Clinical Information
Table 1 presents the sample’s demographic and clinical information. The median age at the time of initial presentation to the plastic surgery clinic was 17 years (IQR, 14–19 y) and ranged from 11 to 22 years. The majority of patients (63%) who presented to the clinic were younger than 18 years. Most patients (83%) were White. The 2 most common diagnoses were Poland syndrome (50%) and tuberous breast (33%). Most patients (97%) had unilateral disease, and the laterality of the affected breast was fairly even, with 53% involving the right breast and 43% the left. All patients had 2 nipples present, although in 37% of patients the nipple was malpositioned. Most patients (73%) had at least some portion of the pectoral muscle present.
Table 1.
Demographic and Clinical Information
| Characteristic | N = 30, n (%) |
|---|---|
| Median (IQR) age at first plastic surgery clinic visit, y | 17 (IQR, 14–19); range, 11–22 |
| Race | |
| African American | 2 (6.7) |
| American Indian/Alaska Native | 1 (3.3) |
| White | 25 (83.3) |
| Other | 1 (3.3) |
| Unknown | 1 (3.3) |
| Diagnosis | |
| Poland syndrome | 15 (50) |
| Tuberous breast | 10 (33.3) |
| Congenital hypoplasia | 2 (6.7) |
| Pectus excavatum | 2 (6.7) |
| Anterior thoracic hypoplasia | 1 (3.3) |
| Median (IQR) body mass index, kg/m² | 25.1 (IQR, 20.1–29.14); range, 17–40 |
| Tobacco use | |
| No tobacco use | 29 (96.7) |
| Current tobacco use | 1 (3.3) |
| Laterality | |
| Unilateral | 29 (96.7) |
| Right | 16 (53.3) |
| Left | 13 (43.3) |
| Bilateral | 1 (3.3) |
| Nipple position | |
| Anatomical | 19 (63.3) |
| Not anatomical | 11 (36.7) |
| Pectoral muscle status | |
| Present | 22 (73.3) |
| Not present | 8 (26.7) |
Stage I of Reconstruction
Table 2 demonstrates the surgical information associated with stage I of reconstruction. The median age at the time of tissue expander placement was 18 years (IQR, 15–20 y; range, 12–23 y), with almost half of the patients (47%) being younger than 18 years and over a quarter of the patients (27%) being younger than 16 years. Most patients (93%) had the tissue expander placed via an inframammary fold incision, whereas 2 (7%) patients had a tissue expander placed via an axillary approach. Patients with an intact pectoralis major (73%) had tissue expanders placed subpectorally, whereas those with an absent pectoralis major (27%) underwent subglandular placement. The most common tissue expander size ranged between 450 and 549 cm3 (40%). The median intraoperative tissue expander fill was 120 cm3 (IQR, 100–180 cm3; range, 0–350 cm3). The median number of in-clinic tissue expander fills was 4 (IQR, 2–5.75; range 1–14 fills). The median final tissue expander fill volume was 520 cm3 (IQR, 360–647.5 cm3; range 145–980 cm3). One patient (3%) underwent replacement of the initial tissue expander with a larger expander 2 years after the first tissue expander placement due to significant contralateral breast growth.
Table 2.
Stage I Surgical Information (Tissue Expander Placement)
| Surgical Information | N = 30, n (%) |
|---|---|
| Median (IQR) age at tissue expander placement, y | 18 (IQR, 15–20); range, 12–23 |
| Incision location | |
| Inframammary fold | 28 (93.3) |
| Axillary | 2 (6.7) |
| Dissection plane | |
| Subpectoral | 22 (73.3) |
| Subglandular | 8 (26.7) |
| Size of tissue expander used, cm3 | |
| <350 cm3 | 6 (20.0) |
| 350–449 cm3 | 5 (16.7) |
| 450–549 cm3 | 12 (40.0) |
| 550–649 cm3 | 6 (20.0) |
| >649 cm3 | 1 (3.3) |
| Median (IQR) intraoperative tissue expander fill, cm3 | 120 (IQR, 100–180); range, 0–350 |
| Median (IQR) no. in-clinic tissue expander fills | 4 (IQR, 2–6); range, 1–14 |
| Median (IQR) final tissue expander fill, cm3 | 520 (IQR, 350–650); range, 145–980 |
Stage II of Reconstruction
Table 3 demonstrates the surgical information associated with stage II of reconstruction. The median age at the time of implant placement was 19 years (IQR, 17–20 y; range 15–24 y), with 30% of patients being younger than 18 years. The median time from tissue expander placement to implant placement was 351.5 days (IQR, 143.25–611.5 d; range 63–2400 d), and the median time from tissue expander final fill to implant placement was 233 days (IQR, 68.75–472.75 d; range 27–1602 d). The most common implant size ranges were 250–349, 350–449, and 450–549 cm3 (23% each). Adjunct procedures were common among our sample population (87%). About 50% of patients underwent contralateral mastopexy at the time of implant placement, 47% of patients underwent contralateral breast implant augmentation, 20% of patients underwent autogenous fat grafting at some point during their reconstruction process, 4 (13%) patients, all of whom were diagnosed with Poland syndrome, had an ipsilateral latissimus dorsi flap harvested at the time of implant placement for chest wall and anterior axillary fold reconstruction, and 2 (6.7%) patients underwent ipsilateral free nipple grafting to improve the position of their nipple–areola complex. The median follow-up time after implant placement was 731.5 days (IQR, 172.25–2555 d).
Table 3.
Stage II Surgical Information (Breast Implant Placement)
| Surgical Information | N = 30, n (%) |
|---|---|
| Median (IQR) age at implant placement, y | 19 (IQR, 17–20); range, 15–24 |
| Median (IQR) time from tissue expander placement to implant placement, d | 351.5 (IQR, 135–630); range, 63–2400 |
| Median (IQR) time from final tissue expander fill to implant placement, d | 150.5 (IQR, 62–412); range, 27–1602 |
| Size of implant used, cm3 | |
| <250 cm3 | 2 (6.67) |
| 250–349 cm3 | 7 (23.33) |
| 350–449 cm3 | 7 (23.33) |
| 450–549 cm3 | 7 (23.33) |
| 550–649 cm3 | 5 (16.67) |
| >649 cm3 | 2 (6.67) |
| Adjunct procedures | 26 (86.7) |
| Fat grafting* | 6 (20) |
| Preimplant placement | 3 (10.0) |
| During implant placement | 2 (6.7) |
| Postimplant placement | 2 (6.7) |
| Contralateral mastopexy at the time of implant placement | 17 (56.7) |
| Contralateral augmentation | 14 (46.7) |
| Ipsilateral muscle flap at the time of implant placement | 4 (13.3) |
| Free nipple grafting | 2 (6.7) |
| Median (IQR) follow-up time after implant placement, d | 731.5 (IQR, 161–2681); range, 7–5662 |
Of the patients who underwent fat grafting, median volume was 146.5 cm3 (IQR, 66–263 cm3; range, 45–320 cm3). One patient underwent fat grafting during preimplant placement and during implant placement.
Complications and Revisions
Table 4 demonstrates the complications (intraoperative, minor, and major) and revisions associated with this 2-stage breast reconstruction. No intraoperative complications occurred in any patients. Ten (33%) patients experienced minor postoperative complications, and 6 (20%) patients experienced major postoperative complications. The most common minor complications were delayed wound healing (10%), striae development (10%), and surgical site infections treated with oral antibiotics (10%). The most common major complication was tissue expander rupture (17%). Of the 6 patients with major complications, 3 had a diagnosis of Poland syndrome, 2 had a diagnosis of tuberous breast deformity, and 1 had a diagnosis of pectus excavatum. Six (20%) patients underwent elective revisions, with contour corrections (10%) and symmetry corrections (7%) being most common.
Table 4.
Complications and Revisions With 2-stage Breast Reconstruction
| Complications and Revisions | N = 30, n (%) |
|---|---|
| 1+ Intraoperative complication(s) | 0 (0) |
| 1+ Minor postoperative complication(s) | 10 (33.3) |
| Capsular contracture | 1 (3.3) |
| Delayed wound healing | 3 (10.0) |
| Hematoma aspiration | 1 (3.3) |
| Scar abnormality | 1 (3.3) |
| Seroma aspiration | 1 (3.3) |
| Striae development | 3 (10.0) |
| Surgical site infection, managed nonoperatively | 3 (10.0) |
| 1+ Major postoperative complication(s)* | 6 (20) |
| Neuroma, with surgical intervention | 1 (3.3) |
| Tissue expander rupture† | 5 (16.7) |
| Ruptured tissue expander replaced with tissue expander | 1 (3.3) |
| Ruptured tissue expander replaced with implant | 4 (13.3) |
| 1+ Revision(s) | 6 (20.0) |
| Contour correction | 3 (10) |
| Nipple revision | 1 (3.3) |
| Scar revision | 1 (3.3) |
| Symmetry correction | 2 (6.7) |
Of the 6 patients with major complications, 3 had a diagnosis of Poland syndrome, 2 had a diagnosis of tuberous breast deformity, and 1 had a diagnosis of pectus excavatum.
Median number of days between tissue expander placement and rupture was 787 d (IQR, 434–1042; range, 173–1870).
DISCUSSION
The present retrospective study evaluated our institution’s 22-year experience with 2-stage breast reconstruction with tissue expanders/implants for AYA patients with congenital breast asymmetry and found 2 principal findings. First, the technique can be used in patients with a range of phenotypes. Second, tissue expansion in patients with congenital breast asymmetry demonstrates comparable rates of complications to other tissue expander–based breast reconstruction approaches. Taken together, we believe this technique to be a reasonable option for individualized treatment of congenital breast asymmetries in AYA patients. This includes patients who present before breast maturity to facilitate the gradual expansion of the affected breast as the contralateral, unaffected breast develops over time.
Our study demonstrates that tissue expander–based reconstruction is a versatile and feasible option for patients with a variety of congenital breast asymmetries and anatomical presentations. Although we did not specifically categorize patients by severity, the cohort included individuals with asymmetries of different etiologies and varying degrees, including 1 patient with severe Poland syndrome who underwent a Ravitch procedure at the time of tissue expander placement and 1 patient with pectus excavatum who underwent Nuss bar placement 3 years after breast implant placement. Furthermore, there was a broad range of tissue expander sizes, intraoperative fill volumes, number of in-clinic tissue expander fills, and final fill volumes, which highlights the adaptability of this approach across diverse patient needs. Although contralateral breast growth beyond the size of the tissue expander remains a possible concern during the expansion period, only 1 patient in our series required reoperation to upsize the initial tissue expander. Importantly, our findings demonstrate that this technique is especially valuable for adolescents who present before completing breast maturation. In our study, more than 63% of patients who presented to our clinic were younger than 18 years, with the youngest patient being 11 years old, and more than a quarter (27%) of patients underwent tissue expander placement before turning 16 years old. Early intervention with tissue expanders allows for individualized, serial breast tissue expansion and helps provide meaningful breast symmetry during a key psychosocial developmental period. Additionally, our findings are consistent with the literature in showing that adjunct procedures are frequently used to optimize cosmetic results.8,9,14–18 Although these adjunct procedures were performed to improve aesthetic outcomes, they did not increase the overall surgical burden. Most patients (80%) underwent only 2 operations: (1) tissue expander placement, and (2) implant placement, sometimes combined with mastopexy, contralateral augmentation, fat grafting, ipsilateral latissimus dorsi muscle flap, or free nipple grafting. This is comparable to the average number of surgeries required for congenital breast asymmetry using other techniques.9,14
Most published studies on breast reconstruction tissue expander complications have focused on oncological patients, with limited data available for the congenital breast asymmetry population. Existing reports on this reconstructive technique are further constrained by small sample sizes or the use of now-less-favored devices, such as the textured-surfaced Becker expander/implant.7,10,19,20 Our current study expands on these findings by presenting surgical outcomes in a larger cohort of patients who have undergone tissue expander reconstruction for congenital breast asymmetry. Additionally, our study challenges the traditional limitation of restricting tissue expander placement to 1 year, as previously described in the oncological population.11 In our cohort, the median duration of tissue expander placement was 351.1 days, with 15 cases extending beyond 1 year, and the longest case lasting more than 6 years. These cases of prolonged tissue expander placement occurred for several reasons, including waiting for contralateral breast maturation and timing around personal and school schedules. Notably, despite these extended expansion periods, complication rates in our cohort remained comparable to those reported for shorter expansion durations in both acquired and congenital populations. Complication rates for implant-based breast reconstruction for acquired deformities have been reported to range from 5.9% to as high as 83%, according to a systematic review by Bucher and Vogt.21 Our study reports 20% of patients experiencing a major complication and 33% of patients experiencing a minor complication. These rates are also comparable to those reported for other techniques used in congenital breast asymmetry reconstruction.5,7,20 Furthermore, although these complication rates are high, previous literature has demonstrated that long-term quality-of-life outcomes may not be negatively impacted when complications are properly managed, patients receive strong provider support in the early postoperative period, and have effective coping skills and social support.22 We also intentionally defined minor complications broadly, including outcomes such as striae development to more accurately represent the recovery process, although many would consider these to be typical postoperative occurrences.
This study should be interpreted in the context of multiple limitations, including its retrospective, single-institution cohort design. Reliance on billing codes may also have failed to accurately capture all relevant clinical diagnoses or procedures, introducing potential selection bias. Although the number of patients who completed 2-stage reconstruction at this institution during the 22-year period is small, this number is aligned with other retrospective studies on congenital breast asymmetry reconstruction.7,10,14–18 Another limitation is the lack of the ability to classify patients based on the severity of their congenital breast disease; however, this also demonstrates that this technique can be used for patients with a variety of phenotypes. Additionally, although anecdotally patients report high satisfaction following this procedure, we are unable to report patient-reported outcomes because they were not systematically collected. Future studies using validated patient-reported outcome measures, such as the BREAST-Q, would provide valuable patient-centered evidence regarding the patient experience of undergoing this procedure.23 Despite these limitations, our study’s findings support this operative technique of using 2-stage reconstruction with tissue expanders for patients with congenital breast asymmetry of various phenotypes.
CONCLUSIONS
This study demonstrates that 2-stage breast reconstruction with tissue expanders is a feasible option for AYA women with congenital breast asymmetry across a range of phenotypes. Complication rates were comparable to those observed in 2-stage reconstruction for acquired breast conditions, as well as to other reconstructive techniques for congenital asymmetry. Our 22-year experience indicates that the use of tissue expanders offers a practical method for gradual adjustment of the affected breast, accommodating the natural development of the unaffected, contralateral breast until the patient is ready for final reconstruction with a permanent implant.
DISCLOSURES
Dr. Haley is supported by the National Clinician Scholars Program within the Institute for Healthcare Policy and Innovation at the University of Michigan. Dr. Haley was previously supported by the National Institutes of Health (grant T32 HS000053). The National Clinician Scholars Program and the National Institutes of Health played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; or decision to submit the article for publication. The other authors have no financial interest to declare in relation to the content of this article.
Footnotes
Published online 1 September 2026.
Drs. Haley and Herman contributed to this work equally and should be considered the cofirst authors.
Previously presented at the “Plastic Surgery The Meeting 2023,” Austin, TX, as a podium presentation by Dr. A.E. Herman on October 27, 2023.
Disclosure statements are at the end of this article, following the correspondence information.
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