title: Breast reconstruction by tissue expansion: What is the integrity of the chest wall?
abstract: BACKGROUND
  Both tissue expanders and implants are commonly used during breast reconstructions. These devices are the preferred choice of many plastic surgeons around the world during breast reconstruction due to their technical ease of use, low comorbidity and safety. However, several issues such as the integrity of the chest wall during and after tissue expansion remain unclear. Here we present a longitudinal study that shows deformities of the chest wall caused by the use of tissue expanders.
  
  
  METHODS
  A prospective longitudinal study of the chest wall in 36 patients who underwent immediate two-stage expander-to-implant reconstruction from 2010 to 2013 was conducted to evaluate the possible causes of chest wall deformity. Computed tomography (CT) scans of the chest walls were taken before the second-stage reconstruction and after 1 year. Chest wall deformities (graded from I, no deformities, to V, costal fracture) were evaluated with CT scans.
  
  
  RESULTS
  This study examined 36 breast reconstructions. Chest wall deformities were observed by a CT scan before the second-stage reconstruction. There were eight patients with grade I scores, 14 with grade II, 10 with grade III and four with grade IV. No cases of costal fracture (grade V) were observed. At the 1-year follow-up after the TE/implant change, 22 patients had the same degree of chest wall deformity. Ten patients showed an improvement and four a higher-grade deformity.
  
  
  CONCLUSIONS
  Chest wall deformities commonly occur after tissue expander/implant reconstruction. However, the size of the expander, reconstruction timing and filling volume are not correlated with deformity development.
authors: Division of Plastic Surgery, Department of Biotechnology and Science of Life, University of Insubria Varese, Italy. Electronic address: mario.cherubino@gmail.com.
authors: Mario
authors: M
authors: Cherubino
authors: Division of Plastic Surgery, Ospedale di Circolo Fondazione Macchi Varese, Italy.
authors: Stefano
authors: S
authors: Scamoni
authors: Division of Plastic Surgery, Department of Biotechnology and Science of Life, University of Insubria Varese, Italy.
authors: Francesca
authors: F
authors: Maggiulli
authors: Division of Radiology, Department of Morphologic and Surgery, University of Insubria Varese, Italy.
authors: Chiara
authors: C
authors: Floridi
authors: Division of Radiology, Department of Morphologic and Surgery, University of Insubria Varese, Italy.
authors: Monica
authors: M
authors: Mangini
authors: Division of Plastic Surgery, Department of Biotechnology and Science of Life, University of Insubria Varese, Italy.
authors: Danilo
authors: D
authors: Di Giovanna
authors: Division of Radiology, Department of Morphologic and Surgery, University of Insubria Varese, Italy.
authors: Carlo
authors: C
authors: Fugazzola
authors: Division of Plastic Surgery, Department of Biotechnology and Science of Life, University of Insubria Varese, Italy.
authors: Luigi
authors: L
authors: Valdatta
mesh_terms: D000328:Adult; D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D035441:Thoracic Wall / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015626:Tissue Expansion / Q000009:adverse effects* / Q000379:methods; D015625:Tissue Expansion Devices / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Breast implant; Breast reconstruction; Chest wall deformity; Tissue expander