RESUMEN
BACKGROUND: Single-stage reconstruction using permanent expander implants is an established technique following mastectomy. Short and long-term outcome data following breast reconstruction using Becker tissue expanders is limited. METHOD: A retrospective case note review of patients undergoing expander-based procedures between 1989 and 2007 was undertaken. Data recorded included postoperative symptoms and complications, the use of radiotherapy, revisional surgery, and device failure. RESULTS: Three hundred and thirteen expanders were used in 276 patients with a mean age of 48.3 (17-78) years, over the 18 year study period. The mean follow up period was 64.6 (1-199) months. 256 Becker expanders were used during 175 latissimus dorsi (LD) and 52 subpectoral (SP) reconstructions, 13 contralateral augmentations and 16 implant replacements. The postoperative infection rate was 5.8%, leading to an expander loss rate of 3.8%. The use of prophylactic antibiotics was associated with an increased postoperative infection rate (p = 0.046). Six haematomas (2.5%) and 12 cases of skin envelope necrosis (5.0%) required unscheduled intervention. Symptoms of pain, distortion and hardness were experienced by 21.3% of patients, and radiotherapy was associated with a significantly higher risk of adverse symptoms (p < 0.0001). No patient developed symptomatic implant rupture or silicone granuloma but 17.9% of reconstructions underwent revisional surgery, the rate being highest following SP reconstruction (p = 0.029). Nine patients developed injection port complications (3.8%), and the overall device failure rate was 1.3%. The original expander has been retained by 74.2% of women. CONCLUSION: The Becker permanent expander is a reliable implant associated with a low complication rate and a high retention rate when used during breast reconstruction.
Asunto(s)
Implantación de Mama/instrumentación , Implantes de Mama , Neoplasias de la Mama/cirugía , Mastectomía , Dispositivos de Expansión Tisular , Adolescente , Adulto , Anciano , Implantación de Mama/métodos , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Falla de Prótesis , Reoperación , Estudios Retrospectivos , Colgajos Quirúrgicos/trasplante , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Nipple-areolar complex (NAC) reconstruction and tattooing complete and compliment reconstruction of the breast mound. Patient satisfaction with NAC reconstruction and tattoo, independent from breast mound reconstruction is evaluated in this study. METHODS: Patients who underwent nipple tattooing between January 2001 and June 2008 were sent a postal questionnaire retrospectively. Questions included those regarding reconstruction type, patient satisfaction with NAC reconstruction and tattoo outcome, and complications. RESULTS: 110 patients with completed questionnaires were included from the 172 patients who were invited. Median follow up time was 38.5 months (1-86). Eighty eight percent reported overall satisfaction with their NAC reconstruction. Seventy percent of patients were satisfied with their nipple tattoos. All procedures were done in a day case setting and eighty-nine patients reported no postoperative complications. The commonest causes for disappointment were lack of projection of the NAC reconstruction and fading of tattoos. Ninety-six percent of women stated that NAC reconstruction and tattooing were important to them, and 93% of the patients would undergo the procedures again. CONCLUSION: We believe that NAC reconstruction is an important and integral part of breast reconstruction. This study should inform surgeons and patients regarding outcome, possible complications and the potential need and timing of further tattooing.