Two Stage Delayed Breast Reconstruction with an Expander and Free Abdominal Tissue Transfer

Abstract

Traditional single stage autologous reconstruction following a non-skin sparing mastectomy leaves a visible skin island on the breast which often contrasts with the surrounding native skin, leaving a patchwork like appearance. The skin paddle is not only insensate but can also transfer hair, striae, scars or tattoos from the donor area. A staged reconstruction involves the creation of a skin envelope with a tissue expander in the first stage which is then replaced with a de-epithelialized flap in the second stage. The two-stage technique not only leaves a breast with the original linear mastectomy scar and eliminates the need for a visible skin paddle, it also produces a sensate breast with a more natural looking breast mound. It is a versatile technique and can be used in both skin sparing and non-skin sparing mastectomy patients in the setting of both immediate and delayed reconstruction depending on the patient’s preference and oncological safety. Furthermore, in the second stage, the created breast pocket can be filled with free tissue transfer from a variety of donor sites as well as pedicled flaps such as a latissimus dorsi. Overall, the staged technique is not only versatile but can lead to improved breast symmetry with an enhanced aesthetic result.