title: A prospective randomized study comparing two different expander approaches in implant-based breast reconstruction: one stage versus two stages.
abstract: BACKGROUND
  Implant-based reconstruction is performed in the majority of women offered primary reconstruction for breast cancer.
  
  
  METHODS
  Two different expander implants were compared prospectively. The primary endpoint was the number of operations needed in each group to obtain patient satisfaction. Secondary endpoints were evaluation of breast volume and shape and aspects of quality of life. Seventy consecutive breast cancer patients were randomized to either a one-stage reconstruction with a round permanent expander implant (Becker 25; n=35) or a two-stage reconstruction with a crescent-shaped expander (LV 133; n=35), later replaced by a form-stable anatomical implant. Thirty patients had to be excluded and 40 patients, 20 in each group, were evaluated. The median follow-up for both groups was 3.5 years (range, 1.5 to 5 years). Plastic cups, plastic casts, and two -and three-dimensional scanning techniques were used for objective assessment of breast volume and shape. The aesthetic outcome was evaluated by a panel of experts and lay people, and by the patients. Quality of life was evaluated with a validated questionnaire (36-Item Short Form Health Survey).
  
  
  RESULTS
  Of the patients in the one-stage group, 70 percent had revision surgery, mostly because of upper pole fullness and poor ptosis. These findings agreed with the data from the two-dimensional scanning and from the expert panel and the patients' subjective judgment. Quality of life was similar in the two groups.
  
  
  CONCLUSIONS
  The permanent expander method failed significantly as a one-stage procedure. The crescent two-stage method gave the most acceptable results both objectively and subjectively.
  
  
  METHODS
  Therapeutic, I.
authors: Stockholm, Sweden From the Department of Molecular Medicine and Surgery, Karolinska Institutet; and the Departments of Breast and Endocrine Surgery, Reconstructive and Plastic Surgery, and Medical Imaging, Karolinska University Hospital.
authors: Catharina
authors: C
authors: Eriksen
authors: Emelie Nordstrand
authors: EN
authors: Lindgren
authors: Jan
authors: J
authors: Frisell
authors: Birgit
authors: B
authors: Stark
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000295:instrumentation / Q000379:methods*; D001943:Breast Neoplasms / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012086:Reoperation; D015625:Tissue Expansion Devices; D016896:Treatment Outcome