Tabbed Tissue Expanders Improve Breast Symmetry Scores in Breast Reconstruction

Background Achieving symmetry is a key goal in breast reconstruction. Anatomically shaped tabbed expanders are a new tool in the armamentarium of the breast reconstruction surgeon. Suture tabs allow for full control over the expander position and thus inframammary fold position, and, in theory, tabbed expanders mitigate many factors responsible for poor symmetry. The impact of a tabbed expander on breast symmetry, however, has not been formally reported. This study aims to evaluate breast symmetry following expander-implant reconstruction using tabbed and non-tabbed tissue expanders.

Methods A chart review was performed of 188 consecutive expander-implant reconstructions that met the inclusion criteria of adequate follow-up data and postoperative photographs. Demographic, oncologic, postoperative complication, and photographic data was obtained for each patient. The photographic data was scored using a 4-point scale assessing breast symmetry by three blinded, independent reviewers.

Results Of the 188 patients, 74 underwent reconstruction with tabbed expanders and 114 with non-tabbed expanders. The tabbed cohort had significantly higher symmetry scores than the non-tabbed cohort (2.82/4±0.86 vs. 2.55/4±0.92, P=0.034).

Conclusions The use of tabbed tissue expanders improves breast symmetry in tissue expander-implant-based breast reconstruction. Fixation of the expander to the chest wall allows for more precise control over its location and counteracts the day-to-day translational forces that may influence the shape and location of the expander pocket, mitigating many factors responsible for breast asymmetry.

Keywords

Breast - Mammaplasty - Tissue expansion devices - Outcome assessment (health care)

John YS Kim receives research funding from the Musculoskeletal Transplant Foundation.

Publikationsverlauf

Eingereicht: 14. Juni 2013

Angenommen: 08. August 2013

Artikel online veröffentlicht:
02. Mai 2022

• REFERENCES

• 1 Baxter NN, Virnig BA, Durham SB. et al. Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst 2004; 96: 443-448
• 2 American Society of Plastic Surgeons. 2012 Plastic surgery statistics report [Internet]. Arlington Heights; American Society of Plastic Surgeons: c2013 [cited 2013 May 26]. Available from: http://www.plasticsurgery.org/Documents/news-resources/statistics/2012-Plastic-Surgery-Statistics/reconstructive-surgery-demographics.pdf
• 3 Wilkins EG, Cederna PS, Lowery JC. et al. Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 2000; 106: 1014-1025
• 4 Pusic AL, Klassen AF, Scott AM. et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009; 124: 345-353
• 5 Pusic AL, Chen CM, Cano S. et al. Measuring quality of life in cosmetic and reconstructive breast surgery: a systematic review of patient-reported outcomes instruments. Plast Reconstr Surg 2007; 120: 823-837
• 6 Bezuhly M, Bucholtz J, Sigurdson L. Less scarring or more symmetry? Reconstruction following metachronous bilateral breast cancer. J Plast Reconstr Aesthet Surg 2012; 65: 1595-1597
• 7 Craft RO, Colakoglu S, Curtis MS. et al. Patient satisfaction in unilateral and bilateral breast reconstruction [outcomes article]. Plast Reconstr Surg 2011; 127: 1417-1424
• 8 Gust MJ, Nguyen KT, Hirsch EM. et al. Use of the tabbed expander in latissimus dorsi breast reconstruction. J Plast Surg Hand Surg 2013; 47: 126-129
• 9 Szychta P, Butterworth M, Dixon M. et al. Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap. Breast 2013; 22: 667-672
• 10 Henseler H, Smith J, Bowman A. et al. Subjective versus objective assessment of breast reconstruction. J Plast Reconstr Aesthet Surg 2013; 66: 634-639
• 11 Fortin AJ, Cheang M, Latosinsky S. Cosmetic outcomes following breast conservation therapy: in search of a reliable scale. Breast Cancer Res Treat 2006; 100: 65-70
• 12 Yesilada AK, Sevim KZ, Sirvan SS. et al. Our surgical approach to treatment of congenital, developmental, and acquired breast asymmetries: a review of 30 cases. Aesthetic Plast Surg 2013; 37: 77-87
• 13 Kasielska A, Antoszewski B. Surgical management of gynecomastia: an outcome analysis. Ann Plast Surg 2013; 71: 471-475
• 14 Harris JR, Levene MB, Svensson G. et al. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys 1979; 5: 257-261
• 15 Radovan C. Breast reconstruction after mastectomy using the temporary expander. Plast Reconstr Surg 1982; 69: 195-208
• 16 Yanko-Arzi R, Cohen MJ, Braunstein R. et al. Breast reconstruction: complication rate and tissue expander type. Aesthetic Plast Surg 2009; 33: 489-496
• 17 Losken A, Carlson GW, Bostwick 3rd J. et al. Trends in unilateral breast reconstruction and management of the contralateral breast: the Emory experience. Plast Reconstr Surg 2002; 110: 89-97
• 18 Buck 2nd DW, Heyer K, DiBardino D. et al. Acellular dermis-assisted breast reconstruction with the use of crescentric tissue expansion: a functional cosmetic analysis of 40 consecutive patients. Aesthet Surg J 2010; 30: 194-200
• 19 McGeorge DD, Mahdi S, Tsekouras A. Breast reconstruction with anatomical expanders and implants: our early experience. Br J Plast Surg 1996; 49: 352-357
• 20 Gui GP, Tan SM, Faliakou EC. et al. Immediate breast reconstruction using biodimensional anatomical permanent expander implants: a prospective analysis of outcome and patient satisfaction. Plast Reconstr Surg 2003; 111: 125-138
• 21 Mahdi S, Jones T, Nicklin S. et al. Expandable anatomical implants in breast reconstructions: a prospective study. Br J Plast Surg 1998; 51: 425-430
• 22 Maxwell GP, Falcone PA. Eighty-four consecutive breast reconstructions using a textured silicone tissue expander. Plast Reconstr Surg 1992; 89: 1022-1034
• 23 FDA. Natrelle 410 highly cohesive anatomically shaped silicone-filled breast implant-P040046 [Internet]. Silver Spring, MD: U.S. Food and Drug Adimistration; c2013 [cited 2013 May 26]. Available from: MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm343639.htm
• 24 Beahm EK, Walton RL. Revision in autologous breast reconstruction: principles and approach. Clin Plast Surg 2007; 34: 139-162
• 25 Stevenson TR, Goldstein JA. TRAM flap breast reconstruction and contralateral reduction or mastopexy. Plast Reconstr Surg 1993; 92: 228-233