title: Tissue Expander Complications Predict Permanent Implant Complications and Failure of Breast Reconstruction.
abstract: BACKGROUND
  Two-stage tissue expander-based breast reconstruction is the most commonly used reconstructive modality following mastectomy. We sought to determine if patients who experienced complications during the expansion phase were at increased risk for complications or reconstructive failure after the exchange procedure.
  
  
  METHODS
  A retrospective review of tissue expander-based breast reconstructions was performed from January 2007 through December 2011. Variables evaluated included age, presence of cancer, tobacco use, body mass index, comorbidities, use of acellular dermal matrix, chemotherapy, radiation, timing of reconstruction (delayed/immediate), intraoperative tissue expander fill, complications, and explantation or salvage of the reconstruction by means of debridement and closure or myocutaneous flap.
  
  
  RESULTS
  A total of 196 patients underwent mastectomy with 304 tissue expander reconstructions. Tobacco use (active and remote), hypertension, and radiation were associated with complications. Patients with a salvaged tissue expander complication were 3 times more likely to have a complication after placement of a permanent implant and 9 times more likely to fail permanent implant reconstruction (ie, require explantation).
  
  
  CONCLUSIONS
  Women with complications after placement of a tissue expander are at significantly increased risk for both complications and reconstructive failure after placement of a permanent implant. Consideration for earlier autologous reconstruction as a salvage should be strongly considered in patients with a tissue expander complication, particularly in smokers and those undergoing radiation therapy.
authors.affiliation: From the *Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI; and †Department of Surgery, Division of Plastic Surgery, and ‡Department of Community Health and Health Studies, Lehigh Valley Health Network, Allentown, PA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Adkinson
authors.forename: Nathan F
authors.initials: NF
authors.lastname: Miller
authors.forename: Sherrine M
authors.initials: SM
authors.lastname: Eid
authors.forename: Marshall G
authors.initials: MG
authors.lastname: Miles
authors.forename: Robert X
authors.initials: RX
authors.lastname: Murphy
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D015626:Tissue Expansion / Q000009:adverse effects*; D015625:Tissue Expansion Devices / Q000009:adverse effects*; D017211:Treatment Failure