Tissue Contraction—A New Paradigm in Breast Reconstruction

Hilton Becker, MD, FACS; Olga Zhadan, MD, MS


Plast Reconstr Surg Glob Open. 2018;6(7):e1865 

In This Article


Twenty consecutive patients (36 breasts) underwent prepectoral breast reconstruction with the Spectrum adjustable implant.

Eighteen patients (90%) had been diagnosed with breast cancer; 15 patients (75%) chose bilateral mastectomy with immediate reconstruction. One patient (5%) had a history of contralateral breast cancer with mastectomy and implant-based reconstruction. One patient (5%) chose to undergo mastectomy and contralateral breast reduction. One patient (5%) had mastectomy of the affected side only. The other 2 patients (10%) had bilateral prophylactic mastectomy for positive BRCA2 genotype and LCIS.

All patients in the series had an excess of skin and/or breast ptosis. Tissue contraction and elevation of the flap occurred in all patients. The exact measurements were not done; however, the amount of elevation is self-evident from the before and after photographs (Figure. 3, Figure 4, Figure 5; Supplemental Digital Content Figure 2).

Figure 3.

Patient with carcinoma of right breast. A, Four weeks following bilateral prophylactic mastectomy with reconstruction. Left breast has become progressively more ptotic. B, Seven weeks postoperative. Left implant deflated to facilitate skin contraction. C, D, Air added. Correction was achieved without further surgery. Three months after breast reconstruction.

Figure 4.

Patient with carcinoma of left breast. A, B, Preoperative views. C, Early postoperative result (3 days) following bilateral mastectomy and prepectoral reconstruction. The Spectrum adjustable implants underfilled with air. D, Six months postoperative, implants filled with saline. E, F, Final result at 7 months following conversion to gel implant. Tattooing of left nipple-areola complex has been performed.

Figure 5.

Patient with carcinoma of right breast, having had previous breast reduction. A, B, Preoperative views. C, Six days following bilateral mastectomy, implants underfilled. D, Following exchange for gel implants, postoperative day 8. E, F, Final result at 2 months.

There was a small amount of air diffusion through the expander. The patients were seen at least weekly for 4 weeks, and air diffusion was not seen as a problem. Five patients (25%) developed seromas. One of them had a recurrent seroma after radiation therapy. Seromas were successfully aspirated with the Blunt SeromaCath.[8] Hematoma evacuation in the early postoperative period was performed in 2 patients. Wound edge necrosis developed in 2 patients (10%). One patient had minimal skin necrosis, which was debrided in the office. The second patient with skin necrosis was successfully treated without implant removal. Emptying the implant completely facilitated correction of these complications. All implants were salvaged.

After the air was converted to saline, 9 patients (45%) requested to proceed with exchange for the gel implant. The time frame for conversion to silicone was a minimum of 3 months to allow wound healing.