Expander/Implant Breast Reconstruction after Reconstruction Using an Extended Cutaneous Thoracoabdominal Flap: A Case Report
In July 2008, a 44-year-old woman underwent extended modified radical mastectomy including only the pectoralis fascia with extensive skin paddle resection for advanced cancer of the left breast (). Immediate chest wall reconstruction was achieved using an extended cutaneous thoracoabdominal flap, 18×20 cm in size, drawn on the homolateral abdominal wall, rotated clockwise in the left chest wall, and adapted to the defect (, ); no complications were recorded. The patient received adjuvant chemotherapy over a 6-month period.\nAfter 2 years of uneventful follow-up, the patient required breast reconstruction. We planned two-stage implant breast reconstruction using a Natrelle 133-850 cc Full Height biodimensional tissue expander (Allergan Inc., Irvine, USA) placed in the subcutaneous plane under the flap through a 5-cm incision overlapping the previous scar on the anterior axillary line. The size of the expander implant was selected according to contralateral breast width, which was measured preoperatively. The inferior border of the expander was placed symmetrical to the contralateral side as planned preoperatively. The expander was then inflated with saline solution at weekly intervals postoperatively to achieve a total volume of 850 cc.\nFour months after expansion, the second stage of the procedure was performed using a Natrelle 410 FF 740-cc anatomical permanent silicone cohesive gel implant (Allergan Inc.); a circumferential basal capsulotomy was performed and the inframammary fold was reconstructed, with the anterior leaf cranially advanced on the chest wall in a "slingshot" fashion. Contralateral augmentation mammaplasty was performed to achieve symmetry between breasts; two closed-suction drains were placed and removed after 6 days. The esthetic outcome was good, as assessed by a blinded expert using standardized patient photographs with frontal and bilateral oblique views, taken at the 1-year follow-up (). Follow-up evaluations included total body computed tomography, ultrasonography of the reconstructed breast, and contralateral mammography of the healthy breast, which did not indicate recurrence.