title: Implications of Long-term Indwelling of Tissue Expander in Breast Reconstruction: Risk of Expander Rupturing.
abstract: OBJECTIVE
  Breast reconstruction with a tissue expander (TE) is associated with postoperative complications, including rupturing of the TE. Any device can have a mechanical failure, and a TE may rupture over time. Although an interval of around one year from initial TE insertion to the second stage of two-stage surgery is historically considered the standard, the optimal interval has not yet been determined. Furthermore, the durability of a TE and the influence of long-term indwelling on TE rupture are uncertain. In this study, we retrospectively investigated the effects of long-term indwelling on TE durability and rupturability.
  
  
  METHODS
  We analyzed 24 patients and 25 breasts with breast cancer that had undergone breast reconstruction with an expander that was indwelling for more than a year. The resected margins were all clear, and none of the patients required postoperative radiotherapy.
  
  
  RESULTS
  From a total of 25 reconstructed breast mounds, the TE ruptured in 4 cases. None of the clinicopathological features, including primary tumor progression, method of operation, presence of adjuvant chemotherapy, was significantly associated with TE rupture. Rupture was observed beginning at 1.5 years after the initial TE insertion. The rupture rate was 32.6% by the third year and 55.1% by five years. There were no ruptures among cases with TE exchange within a year.
  
  
  CONCLUSIONS
  Long-term indwelling of TE is associated with TE rupture. We recommend that the appropriate interval between the first and second stages of breast reconstructive surgery is aproximatelly one year.
authors.affiliation: Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan ftakaaki@gunma-u.ac.jp.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan.
authors.forename: Reina
authors.initials: R
authors.lastname: Yajima
authors.affiliation: Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology / Q000601:surgery*; D019928:Breast Implantation / Q000009:adverse effects; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D011183:Postoperative Complications; D015625:Tissue Expansion Devices / Q000009:adverse effects*
keywords: Tissue expander; breast reconstruction; complication; long duration; rupture