INMEDIATE BREAST RECONSTRUCTION WITH ANATOMICAL EXPANDERS: AN APPROACH FEASIBLE TO OBTAIN GOOD RESULTS

Abstract

There is evidence on the benefits of immediate breast reconstruction following a mastectomy. Objective: The aim of this study is to evaluate our experience with anatomical expanders in immediate breast reconstruction. Methods: This study included 60 consecutive patients from CECLINES´ database in Caracas, Venezuela (2009-2013), in which an immediate breast reconstruction with anatomical expander (IBRAE) was performed. Anthropometric and surgical data was prospectively collected.
Cosmetic evaluation consisted of a five-point scale, recorded during follow-up. Analog numerical scale (ENA) established thetructions for IBRAE were: The need for radiotherapy (RT), the need for an implant> 300cc for a reconstruction of one stage and if a thin major pectoral muscle that does not allow making full muscle coverage for an implant-based reconstruction. Results: The mean age of patients was 48.5 years (SD 10.5). The average follow-up was 23.5 months (11-60). The average tumor size was 40 mm (SD 22). In 33.3% (20/60) of patients a nipple-sparing mastectomy was performed with a nipple-areola complex necrosis of 5% (1/20). The average body mass index (BMI) was 26.3 kg / m² (SD 4.5). The 90% of cosmetic scores were 4-5 (good-excellent), with a participation rate of 73% (44/60). In the rating collected by the ENA 39% of the patients had no pain and 10% had high-intensity pain or intolerable. The overall complication rate was 20% (12/60). The most frequent complications were:
capsular contracture to 5%, infection 6.6% and 3.3% hematoma. A BMI> 30 kg / m2 was associated with greater likelihood for complications (OR = 4.6; 95% CI: 1.2 - 18.1, p = 0.021). The Rt was not a variable that attributed risk for complications (OR = 1.4; 95% CI: 0.4 - 4.9, p = 0.826). The extrusion rate was 10% for expanders. The placement of an expander > 500cc was a risk factor for extrusion without statistical significance (RR = 6.0, 95% CI 0.74-48.59, p = 0.0932, OR = 6.8, 95% CI 0.74-61.88, p = 0.088). The extrusion rate of implant in the second stage of reconstruction was 3.7%. Conclusion: IBRAE is an excellent approach in selected patients, reaching a low rate of complications, low extrusion rate and providing a good cosmetic outcome. Obese patients should be warned about the high likelihood of complications due to their condition. 
sensation of pain during expansion in a ten-point scale. The ins-