title: Two-stage delayed breast reconstruction with an expander and free abdominal tissue transfer: outcomes of 65 consecutive cases by a single surgeon.
abstract: BACKGROUND
  Traditional 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.
  
  
  METHODS
  Consecutive 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK. stadiparthi@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Tadiparthi
authors.forename: M
authors.initials: M
authors.lastname: Alrawi
authors.forename: N
authors.initials: N
authors.lastname: Collis
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D013524:Surgical Flaps; D015626:Tissue Expansion; D015625:Tissue Expansion Devices