Two Stage Breast Reconstruction with McGhan 133 LV Expanders and McGhan 363 LF Implants:

A Review of 82 Breast Reconstructions in 62 Patients

Gregory R. Scott, MD

Cynthia L. Carson, PA-C

Gregory L. Borah, MD

INTRODUCTION: Breast reconstruction with tissue expansion and implants remains an important option for the post-mastectomy patient (1-4). This option allows for excellent reconstructive results with less morbidity and disability (short and long term) compared to autologous breast reconstruction, letting the patient resume her usual lifestyle in a timely fashion. We undertook a review of 82 two-stage breast reconstructions in 62 consecutive patients by a single surgeon using the McGhan 133 LV (low profile) expander and the McGhan 363 LF (low height) breast implant. The combination of these devices allows for maximum centralized lower pole projection during expansion and a low height, full projection implant reconstruction.

METHODS: The medical records of 62 consecutive patients undergoing 82 two-stage breast reconstructions by a single surgeon were reviewed. To be included in the review, the reconstruction was considered “complete” (nipple reconstruction completed or declined by the patient and all necessary revisions performed).

RESULTS: Sixty two patients underwent 82 breast reconstructions from 2000-2006 by a single surgeon using the McGhan 133 LV expander and the McGhan 363 LF implant. The average age was 54 years (range 24-82 years). Fifty three (65%) were immediatereconstructions and 29 (35%) were delayed. For the delayed reconstructions, the interval from mastectomy to expander placement was 26 months (range 2.5 months-9years). Thirty seven reconstructions (45%) were for Stage I breast cancer; 21 reconstructions (26%) were for Stage II breast cancer; 17 reconstructions (21%) were prophylactic mastectomies with contralateral breast cancer; 6 reconstructions (7%) were prophylactic for 3 patients with BRCA+ gene; and one reconstruction (1%) for Stage III breast cancer. Twenty three patients (37%) received adjuvant chemotherapy. Six patients received chemotherapy during the expansion process. No reconstructions were performed on previously irradiated tissue, however two patients received radiation therapy to the fully filled expander prior to permanent implant placement. The expansion interval (from expander placement to implant placement) averaged 4.5 months (range 2-15 months). The total reconstruction time (expander placement to nipple reconstruction) averaged 10 months (range 5-32 months). Five patients chose not to undergo nipple reconstruction. Early complications (prior to completion of reconstruction) occurred in 6% of cases including one expander infection and one implant infection, both necessitating conversion to latissimus dorsi flap breast reconstructions. Two patients developed cellulitis during the expansion process resolving with oral antibiotics. In one patient the expander was inadvertently punctured with a needle during the expansion process. She subsequently underwent successful implant placement. Late complications (following completion of the reconstruction) included 6 patients (7.3%) who underwent correction of asymmetry with implant exchange; 5 patients (6%) who underwent free fat transfer (Coleman system) for superior perimeter defects; and 3 patients (3.6%) who underwent replacement of deflated implants.

CONCLUSION: Two-stage breast reconstruction with the McGhan 133 LV expander and the McGhan 363 LF implant gives excellent results with low morbidity, reduced recovery times and lessened short and long term disability. This particular combination of reconstructive devices allows for preferential fuller projection of the lower pole of the reconstructed breast, maximizing the contour of the inframammary fold and lateral fullness.

REFERENCES

  1. Cordeiro P, McCarthy C. A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction: Part I. A prospective analysis of early complications. Plast Reconstr Surg 118:825-831, 2006.
  2. Cordeiro P, McCarthy C. A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction: Part II. An analysis of long term complications, aesthetic outcomes, and patient satisfaction. Plast Reconstr Surg 118:832-839, 2006.
  3. Saulis A, Mustoe T, Fine N. A retrospective analysis of patient satisfaction with immediate postmastectomy breast reconstruction: Comparison of three common procedures. Plast Reconstr Surg 119: 1669-1676, 2007.
  4. Spear S, Pelletiere C. Immediate breast reconstruction in two stages using textured, integrated-valve tissue expanders and breast implants. Plast Reconstr Surg 113:2098-2103, 2004