Single-Stage Breast Reconstruction Using an All-In-One Adjustable Expander/Implant

Background: When tissue expansion is necessary in breast reconstruction, a single-stage approach is possible using adjustable expander/implants, with or without the use of acellular dermal matrix. We aimed to present the senior author's single-stage experience over a period of 12 years using combined expander/implants in breast reconstruction. Methods: This is a Single-institution, retrospective review of breast reconstruction with combined expander/implants from 2002 to 2014. Logistic regression was performed to evaluate the impact of multiple variables on long-term outcomes. Results: A total of 162 implants in 105 patients were included in this study. Mean follow-up time was 81.7 months (SD, ± 39.2; range, 15–151). Complication rates were as follows: 0.62% extrusion, 1.2% mastectomy flap necrosis, 1.2% hematoma, 1.9% dehiscence, 2.5% seroma, 4.9% infection, and 15.4% deflation. The following associations were identified by logistic regression: adjuvant radiotherapy and capsular contracture (P = 0.034), tumor size and deflation (P = 0014), and smoking history and infection (P = 0.013). Conclusions: Overall, 81% of breasts were successfully reconstructed in a single stage. Single-stage reconstruction using all-in-one expander/implants reduces costs by eliminating the need for a second procedure under general anesthesia and can achieve results comparable with other alloplastic reconstructions reported in the literature. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 11 January 2018. Received for publication September 19, 2017; accepted October 25, 2017. We have received ethical approval by our institution's ethics committee. We have followed the World Medical Association's Declaration of Helsinki. Presented at the Canadian Society of Plastic and Reconstructive Surgeons (CSPS) Annual Meeting, June 2016, Ottawa, ON; L'Association des Spécialistes en Chirurgie Plastique et Esthétique du Québec (ASCPEQ) annual meeting, February 2017, Montreal, QC; Fraser Gurd Surgical Research Forum, McGill University, May 2016, Montreal, QC; American Society of Plastic Surgeons (ASPS) Annual Meeting, October 2017, Orlando, FL. Disclosure: The video was financed by Mentor. The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid by the authors. Supplemental digital content is available for this article. Clickable URL citations appear in the text. Lucie Lessard, MD, FRCSC, FACS, Division of Plastic and Reconstructive Surgery, McGill University Health Center, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, E-mail: lucie.lessard@mcgill.ca Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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