title: The impact of postoperative expansion initiation timing on breast expander capsular characteristics: a prospective combined clinical and scanning electron microscopy study.
abstract: BACKGROUND
  In the first stage of expander-to-implant breast reconstruction, postoperative expansion is classically initiated at 10 to 14 days (conventional approach). The authors hypothesized that it may be beneficial to wait 6 weeks postoperatively before initiating serial expansion (delayed approach). Clinical and ultrastructural periprosthetic capsule analysis is first required before determining whether a delayed approach ultimately improves capsular tissue adherence and expansion process predictability.
  
  
  METHODS
  Patients undergoing two-stage implant-based breast reconstruction were enrolled prospectively in this study. During expander-to-implant exchange, the clinical presence of "Velcro" effect, biofilm, and double capsule was noted. Periprosthetic capsule samples were also sent for scanning electron microscopic observation of three parameters: surface relief, cellularity, and biofilm. Samples were divided into four groups for data analysis (group 1, conventional/Biocell; group 2, delayed/Biocell; group 3, conventional/Siltex; and group 4, delayed/Siltex).
  
  
  RESULTS
  Fifty-six breast reconstructions were included. Each group comprised between 13 and 15 breasts. In group 1, no cases exhibited the Velcro effect and there was a 53.8 percent incidence of both biofilm and double capsule. In group 2, all cases demonstrated the Velcro effect and there were no incidences of biofilm or double capsule. Group 3 and group 4 cases did not exhibit a Velcro effect or double-capsule formation; however, biofilm was present in up to 20.0 percent. All group 2 samples revealed more pronounced three-dimensional relief on scanning electron microscopy.
  
  
  CONCLUSIONS
  Variations in expansion protocols can lead to observable modifications in periprosthetic capsular architecture. There may be real benefits to delaying expander inflation until 6 weeks postoperatively with Biocell expanders.
authors: Montreal, Quebec, Canada From the Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center, and the Department of Chemical Engineering, École Polytechnique, Université de Montréal.
authors: Laurence S
authors: LS
authors: Paek
authors: Jean-Philippe
authors: JP
authors: Giot
authors: Jean-Olivier
authors: JO
authors: Tétreault-Paquin
authors: Samuel
authors: S
authors: St-Jacques
authors: Monica
authors: M
authors: Nelea
authors: M Alain
authors: MA
authors: Danino
mesh_terms: D001940:Breast / Q000601:surgery* / Q000648:ultrastructure*; D019928:Breast Implantation / Q000379:methods*; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D057910:Implant Capsular Contracture / Q000473:pathology; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D013997:Time Factors; D015626:Tissue Expansion; D015625:Tissue Expansion Devices