title: Is mammary reconstruction with the anatomical Becker expander a simple procedure? Complications and hidden problems leading to secondary surgical procedures: a follow-up study.
abstract: Debate over the role of Becker expander implants (BEIs) in breast reconstruction is still ongoing. There are no clear indications for BEI use. The main indications for BEI use are one-stage breast reconstruction procedure and congenital breast deformities correction, due to the postoperative ability to vary BEI volume. Recent studies showed that BEIs were removed 5 years after mammary reconstruction in 68% of operated patients. This entails a further surgical procedure. BEIs should not, therefore, be regarded as one-stage prostheses. We performed a case-series study of breast reconstructions with anatomically shaped Becker-35™ implants, in order to highlight complications and to flag unseen problems, which might entail a second surgical procedure. A total of 229 patients, reconstructed from 2005 to 2010, were enrolled in this study. Data relating to implant type, volume, mean operative time and complications were recorded. All the patients underwent the same surgical procedure. The minimum follow-up period was 18 months. During a 5-year follow-up, 99 patients required secondary surgery to correct their complications or sequelae; 46 of them underwent BEI removal within 2 years of implantation, 56 within 3 years, 65 within 4 years and 74 within 5 years. Our findings show that two different sorts of complications can arise with these devices, leading to premature implant removal, one common to any breast implant and one peculiar to BEIs. The Becker implant is a permanent expander. Surgeons must, therefore, be aware that, once positioned, the Becker expander cannot be adjusted at a later date, as in two-stage expander/prosthesis reconstructions for instance. Surgeons must have a clear understanding of possible BEI complications in order to be able to discuss these with their patients. Therefore, only surgeons experienced in breast reconstruction should use BEIs.
authors.affiliation: University of Sassari, Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery Unit, Viale San Pietro 43, 07100 Sassari, Italy. farace@uniss.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Farace
authors.forename: Mario
authors.initials: M
authors.lastname: Faenza
authors.forename: Antonio
authors.initials: A
authors.lastname: Bulla
authors.forename: Corrado
authors.initials: C
authors.lastname: Rubino
authors.forename: Gian Vittorio
authors.initials: GV
authors.lastname: Campus
mesh_terms: D000328:Adult; D000368:Aged; D018427:Breast Implants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery*; D011474:Prosthesis Design; D012086:Reoperation; D012307:Risk Factors; D015625:Tissue Expansion Devices; D016896:Treatment Outcome