Two-stage delayed breast reconstruction with an expander and free abdominal tissue transfer: Outcomes of 65 consecutive cases by a single surgeon

SummaryBackgroundTraditional single-stage breast reconstruction with autologous tissue leaves an obvious skin island. Alternatively, a staged reconstruction with the creation of a skin envelope with a tissue expander which is then replaced with a de-epithelialised flap, leaves a breast with the original mastectomy scar and no skin island.MethodsConsecutive patients who underwent the two-stage reconstruction between 2004 and 2010 were included in the study. Data were collected retrospectively on patient demographics, adjuvant treatments, surgical procedures and outcomes.ResultsA total of 65 patients who initially had a non-skin sparing mastectomy underwent two-stage breast reconstruction, of which the majority were delayed (n = 63, 95%) and unilateral (n = 64, 98.5%).Each patient was individually assessed for their suitability for the two-stage reconstruction. In 89% (n = 58) of cases, the expander was inserted in a subcutaneous pocket, while in the remaining a subpectoral pocket was elected. After the first stage, seven complications were recorded (10.7%), notably three expander extrusions, three seromas and one implant infection. Of the 65 patients, 63 proceeded to the second stage of reconstruction with 38 transverse rectus abdominis myocutaneous (TRAM) (60%), 12 superficial inferior epigastric artery (SIEA) (19%), and 13 deep inferior epigastric perforator (DIEP) (21%) flaps. Mean follow-up time since the completion of the second stage was 42 months (range 6–80 months), with complete flap loss recorded in 4.6% and minor fat necrosis in 9.5% of cases.ConclusionsThe two-stage breast reconstruction using skin expansion and autologous tissue transfer eliminates the need for a visible skin paddle and produces a sensate breast with a more natural-looking breast mound.