Skip to main content

Advertisement

SpringerLink
Log in

Becker Expander-Based Breast Reconstruction Following Wise Pattern Skin-Reducing Mastectomy: Complication Rates and Risk Factors

  • Original Article
  • Breast Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Our aim is to analyze the results of immediate breast reconstruction in women with macromastia after skin-reducing mastectomy (SRM), with an emphasis on complications and risk factors. Between 2008 and 2013, fifty women with hypertrophic breasts, aged 21–74 years, underwent immediate expander-based breast reconstruction after Wise pattern SRM. An inferiorly based de-epithelialized skin flap was sutured to the inferolateral border of the pectoralis major muscle and covered the expander. Thirty-five women had a unilateral and fifteen a bilateral procedure (total 65 breasts). In all cases, Becker-35 expanders of volume ranging from 365 to 685 cc were used. Risk factors (BMI, smoking, expander’s size, preoperative irradiation, chemotherapy) and complications were recorded. Follow-up up to 60 months was compiled. In all cases, the myodermal pouch provided safe coverage and support of the expander. Postoperative complications occurred in 18 out of 65 breasts (27.6%) and included skin ischemia in 11 breasts (16.9%), late infection in two (3%), seroma and expander rotation in four and one, respectively (6.1 and 1.5%), and severe peri-prosthetical contraction in five breasts (7.6%). Statistical analysis showed that complications were significantly related to preoperative radiotherapy and smoking; no significant correlation was documented between complication rates and chemotherapy, BMI, age or expander’s size. We suggest that the inverted-T SRM, creating a combined “myodermal” flap for the coverage of a Becker expander, is a useful single-stage reconstructive option for patients with macromastia. Preoperative radiotherapy is significantly related to higher postoperative complication rates, and may result in a less optimal reconstructive outcome.

Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Carlson GW, Bostwick J 3rd, Styblo TM, Moore B, Bried JT, Murray DR, Wood WC (1997) Skin-sparing mastectomy. Oncologic and reconstructive considerations. Ann Surg 225:570–575

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Irwin GW, Black A, Refsum SE, McIntosh SA (2013) Skin-reducing mastectomy and one-stage implant reconstruction with a myodermal flap: a safe and effective technique in risk-reducing and therapeutic mastectomy. J Plast Reconstr Aesthet Surg 66:1188–1194

    Article  CAS  PubMed  Google Scholar 

  3. Bostwick J (1990) Total mastectomy with breast skin and volume reduction using an inverted T incision. In: Bostwick J III (ed) Plastic and reconstructive breast surgery, vol II. Quality Medical Publishing, St Louis, pp 1048–1054

    Google Scholar 

  4. Nava M, Cortinovis U, Ottolenghi J, Riggio E, Pannati A, Catanuto G, Greco M, Rovere GQ (2006) Skin-reducing mastectomy. Plast Reconstr Surg 118:603–610

    Article  CAS  PubMed  Google Scholar 

  5. Losken A, Collins BA, Carlson GW (2010) Dual-plane reconstruction using modified Wise pattern mastectomy and fasciocutaneous flap in women with macromastia. Plast Reconstr Surg 126:731–738

    Article  CAS  PubMed  Google Scholar 

  6. Demiri E, Sapountzis S, Dionyssiou D, Antoniou A (2013) An original technique for securing the inflation port in Becker implant-based breast reconstruction. Plast Reconstr Surg 132:465e–466e

    Article  CAS  PubMed  Google Scholar 

  7. Woo KJ, Paik JM, Mun GH, Pyon JK, Bang SI (2016) Risk factors for complications in immediate expander-implant breast reconstruction for non-obese patients: impact of breast size on complications. Aesthet Plast Surg 40:71–78

    Article  Google Scholar 

  8. Parrett BM, Pribaz JJ, Jones GE (2011) Decisions in breast reconstruction. In: Jones G (ed) Bostwick’s plastic and reconstructive breast surgery, 3rd edn. Quality Medical Publishing, St Louis, pp 869–900

    Google Scholar 

  9. Fischer JP, Cleveland EC, Nelson JA, Kovach SJ, Serletti JM, Wu LC, Kanchwala S (2013) Breast reconstruction in the morbidity obese patient: assessment of 30-day complications using the 2005 to 2010 National Surgical Quality Improvement Program data sets. Plast Reconstr Surg 132:750–761

    Article  CAS  PubMed  Google Scholar 

  10. Hammond DC, Capraro PA, Ozolins EB, Arnold JF (2002) Use of a skin-sparing reduction pattern to create a combination skin-muscle flap pocket in immediate breast reconstruction. Plast Reconstr Surg 110:206–211

    Article  PubMed  Google Scholar 

  11. Skoll PJ, Hudson DA (2002) Skin-sparing mastectomy using a modified wise pattern. Plast Reconstr Surg 110:214–217

    Article  PubMed  Google Scholar 

  12. Della Rovere GQ, Nava M, Bonomi R, Catanuto G, Benson JR (2008) Skin-reducing mastectomy with breast reconstruction and sub-pectoral implants. J Plast Reconstr Aesthet Surg 61:1303–1308

    Article  PubMed  Google Scholar 

  13. Nair A, Jaleel S, Abbott N, Buxton P, Matey P (2010) Skin-reducing mastectomy with immediate implant reconstruction as an indispensable tool in the provision of oncoplastic breast services. Ann Surg Oncol 17:2480–2485

    Article  PubMed  Google Scholar 

  14. Korwar V, Skillman J, Matey P (2014) Skin reducing mastectomy and immediate reconstruction: the effect of radiotherapy on complications and patient reported outcomes. Eur J Surg Oncol 40:442–448

    Article  CAS  PubMed  Google Scholar 

  15. Hugues K, Brown C, Perez V, Ting JW, Rozen WM, Whitaker IS, Korentager R (2012) The effect of radiotherapy on implant-based breast reconstruction in the setting of skin-sparing mastectomy: clinical series and review of complications. Anticancer Res 32:553–557

    Google Scholar 

  16. Kronowitz SJ, Robb GL (2009) Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg 124:395–408

    Article  CAS  PubMed  Google Scholar 

  17. Lam TC, Hsieh F, Boyages J (2013) The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction: a systematic review. Plast Reconstr Surg 132:511–518

    Article  CAS  PubMed  Google Scholar 

  18. Ladizinsky DA, Sandholm PH, Jewett ST, Shahzad F, Andrews K (2013) Breast reconstruction with the Bostwick autoderm technique. Plast Reconstr Surg 132:261–270

    Article  CAS  PubMed  Google Scholar 

  19. Camilleri IG, Malata CM, Stavrianos S, McLean NR (1996) A review of 120 Becker permanent tissue expanders in reconstruction of the breast. Br J Plast Surg 49:346–371

    Article  CAS  PubMed  Google Scholar 

  20. Salgarello M, Visconti G, Barone-Adesi L, Franceschini G, Magno S, Terribile D, Masetti R (2012) Inverted-T skin-reducing mastectomy with immediate implant reconstruction using the submuscular-subfascial pocket. Plast Reconstr Surg 130:31–41

    Article  CAS  PubMed  Google Scholar 

  21. Chang LY, Hargreaves W, Segara D, Moisidis E (2013) Experience in dermomyofascial pouch coverage of immediate implants following skin sparing reduction mastectomy. ANZ J Surg 83:135–138

    Article  PubMed  Google Scholar 

  22. Gentileschi S, Bracaglia R, Garganese G, Gallucci V, Corrado G, Pacelli F, Scambia G (2013) Immediate definitive prosthetic reconstruction in patients with ptotic breasts. Ann Plast Surg 70:144–148

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece

    E. Demiri, D. Dionyssiou, S. Sapountzis, L. Pavlidis & S. Miliaras

  2. Interbalkan Medical Center, Thessaloniki, Greece

    I. Natsiopoulos

Authors
  1. E. Demiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Dionyssiou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Sapountzis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Pavlidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. I. Natsiopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Miliaras
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Demiri.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Demiri, E., Dionyssiou, D., Sapountzis, S. et al. Becker Expander-Based Breast Reconstruction Following Wise Pattern Skin-Reducing Mastectomy: Complication Rates and Risk Factors. Aesth Plast Surg 41, 304–311 (2017). https://doi.org/10.1007/s00266-016-0732-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-016-0732-8

Keywords

Search

Navigation