The Impact of Subpectoral Tissue Expander Applications on Thoracic Deformity: Retrospective Analytic Study on Mastectomy Patients.

Abstract

Introduction: With the rising incidence of breast cancer, post-mastectomy breast reconstructions have become increasingly common. Early implant-based reconstructions placed implants subcutaneously, leading to complications, like flap necrosis and implant malposition. Subsequently, the sub-muscular approach gained popularity for its improved outcomes. Tissue expanders have become integral to breast reconstruction, offering a two-stage process with reduced morbidity. However, their use poses challenges, such as chest wall deformities, influenced by a range of variables (age, radiotherapy, and expander volume). This study aimed to explore these correlations.

Materials and methods: This retrospective study obtained ethical approval and consent was given by 47 patients undergoing immediate two-stage expander-to-implant breast reconstruction between 2013 and 2023. Sterno-costal angles, total expander volume, perioperative filling, and radiotherapy (RT) were evaluated. Pre- and postoperative imaging, including CT and PET-CT scans, assessed chest wall deformities. Patients with osteoporosis, smokers, or pre-existing chest wall deformities were excluded. Standard reconstruction involved creating a sub-muscular pocket, with expanders fixed to the sixth costal periosteum.

Results: Sixty-nine breast of the 47 patients (median age 44 years) were included. Postoperative RT was administered to 46 breasts. Median total expander volume was 360 mL, with an initial fill volume of 45 mL. Postoperative mastectomy wound complications affected eight breasts and were resolved with dressings. Chest wall deformity, indicated by significant postoperative sterno-costal angle changes (p < 0.001), was observed in 82.6% of breasts. No significant differences were found between right- and left-sided deformities (p = 0.47), nor were correlations noted with RT (p = 0.57), total expander volume (p = 0.271), or initial filling volume (p = 0.759).

Conclusion: This study confirms the association between tissue expanders and chest wall deformities in breast reconstruction. Despite the absence of significant correlations with age, RT, or expander volume, the high incidence of deformities highlights the need for further investigation. Understanding these relationships is crucial for optimizing outcomes in breast reconstruction procedures involving tissue expanders.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .