Long-term reconstructive outcomes after expander-implant breast reconstruction with serious infectious or wound-healing complications

Ann Plast Surg. 2012 Apr;68(4):369-73. doi: 10.1097/SAP.0b013e31823aee67.


Introduction: Immediate expander-implant breast reconstruction has been associated with postoperative complications, including infection and wound-healing problems. In extreme cases, these issues can lead to expander-implant loss. Little is known about the long-term reconstructive outcomes for patients who develop major complications threatening their expander-implant reconstructions.

Methods: A review of all patients who underwent mastectomy and immediate expander-implant reconstruction at University of California, San Francisco (UCSF) from 2005 to 2007 was performed. A prospective database was queried for patients who developed a major postoperative complication related to infection or wound-healing problems requiring unplanned operative intervention. Only patients who had a minimum of 3 years' follow-up were included in the study.

Results: Twenty-nine patients were identified who met study criteria. Mean follow-up time was 52.5 months (range, 41-71 months). Six of the 29 (20.7%) patients had received prior breast irradiation, and 9 patients (31%) underwent postoperative radiation therapy. Reasons for unplanned return to the operating room included infection (n = 11, 37.9%), expander-implant exposure (n = 5, 17.2%), nonhealing wounds without underlying exposure (n = 3, 1.3%), or >1 of these indications (n = 10, 34.5%). Unplanned operative intervention (such as wound debridement or expander-implant exchange or removal) was required once in 10 patients (34.5%), twice in 10 patients (34.5%), 3 times in 4 patients (13.8%), 4 times in 1 patient (3.4%), and 5 or greater times in 4 patients (13.8%). At the conclusion of all operative interventions, 15 patients (51.7%) had successful breast reconstruction using an expander-implant technique. Five additional patients (17.3%) ultimately achieved successful salvage reconstruction with either a transverse rectus abdominis myocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flap. Nine patients (31%) did not have successful breast reconstruction. Of these 9 patients, 5 elected to abandon reconstructive efforts after 1 unplanned return to the operating room for expander-implant removal, whereas the rest underwent at least 1 attempt at expander-implant salvage, with the overall rate of final successful reconstruction after attempt at salvage 83.3% (20 of 24 patients).

Conclusions: Even when unplanned operative intervention is required to address postoperative wound-healing or infectious complications after expander-implant reconstruction, the majority of patients can achieve successful reconstructive outcomes at long-term follow-up, including those patients requiring multiple operative interventions to treat their complication.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Breast Implants / adverse effects*
  • Breast Neoplasms / drug therapy
  • Breast Neoplasms / radiotherapy
  • Breast Neoplasms / surgery
  • Databases, Factual
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Mammaplasty / adverse effects*
  • Mammaplasty / methods
  • Mastectomy / methods
  • Middle Aged
  • Postoperative Care / methods
  • Prospective Studies
  • Prosthesis Failure
  • Prosthesis-Related Infections / diagnosis
  • Prosthesis-Related Infections / epidemiology*
  • Reoperation / statistics & numerical data
  • Risk Assessment
  • Severity of Illness Index
  • Surgical Wound Infection / diagnosis
  • Surgical Wound Infection / epidemiology*
  • Time
  • Tissue Expansion / adverse effects*
  • Tissue Expansion / methods
  • Tissue Expansion Devices
  • Treatment Outcome
  • Wound Healing / physiology*