title: Breast reconstruction using permanent Becker expander implants: an 18 year experience.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  The Becker permanent expander is a reliable implant associated with a low complication rate and a high retention rate when used during breast reconstruction.
authors.affiliation: Breast Unit, Royal Hampshire County Hospital, Winchester, SO22 5DG, UK. stevengoh@doctors.net.uk
authors.forename: S C J
authors.initials: SC
authors.lastname: Goh
authors.forename: A L
authors.initials: AL
authors.lastname: Thorne
authors.forename: G
authors.initials: G
authors.lastname: Williams
authors.forename: S A M
authors.initials: SA
authors.lastname: Laws
authors.forename: R M
authors.initials: RM
authors.lastname: Rainsbury
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000295:instrumentation* / Q000379:methods; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000637:transplantation; D015625:Tissue Expansion Devices; D016896:Treatment Outcome; D055815:Young Adult