INTRODUCTION: Nearly 75% of breast reconstruction procedures performed by ASPS members in 2015 involved tissue expanders. Despite the advantages of expander-based reconstruction, complications are common and can require early removal of the tissue expander. Patient preference and oncologic factors may also prompt unanticipated removal of the tissue expander. We present our experience with tissue expander failures in breast reconstruction patients.
METHODS: After IRB approval, a retrospective review was performed of breast reconstruction patients who underwent early tissue expander removal from January 2009 to November 2015. Data was collected from medical records including the reason for early tissue expander removal. The surgical outcome was described as continuing or abandoning breast reconstruction after tissue expander removal and type of breast reconstruction in patients who proceeded. Wilcoxon rank sum test, Chi-squared test, and multivariable logistic regression were used to identify predictors of continuing breast reconstruction after early tissue expander removal.
RESULTS: A total of 137 patients were included. Mean age was 53 years (range: 26–74 years). Reasons for premature tissue expander removal were infection (51%), patient preference (18%), exposure (8%), oncologic reasons (6%), wound issues (5%), pain (4%), and other (7%). Forty-three percent of patients (95% confidence interval: 34–52%) continued with breast reconstruction. In univariate analysis, factors associated with continuing breast reconstruction included bilateral reconstruction (p=0.009), shorter time with tissue expander (p=0.003), presence of a contralateral tissue expander (p<0.001), younger age (p<0.001), and infection causing expander removal (p<0.001). Of these, infection causing expander removal (p=0.038), younger age (p=0.024), and shorter time with tissue expander (p=0.005) were still significant, independent predictors of continuing reconstruction with multivariable analysis. Successful final reconstruction was achieved with autologous reconstruction in 26 patients (48%), implants in 20 patients (37%), and combination of both in 4 patients (7%). Four patients (7%) failed final reconstruction.
CONCLUSION: Tissue expanders are a key feature of breast reconstruction. To our knowledge, this is the most comprehensive description of tissue expander failure long-term outcomes to date. Most early tissue expander removals are due to infection and a considerable portion of patients abandon reconstruction. New factors have been identified which may predict patients likely to continue breast reconstruction after early tissue expander removal. Both implant-based and autologous reconstruction may be utilized for successful final reconstruction in these patients.