Safety of Using Alternate Incision for Tissue Expander Exchange to Implant in Breast Reconstruction, 

Idanis Perez-Alvarez MD, Annie Fritsch BS, Nikki Rezania MD, Rachel Williams MD, Santiago Ceron MD, Hannah Carr MD, Jaime Pardo Palau MD, MS, Deana Shenaq MD

Rush University Medical Center

Purpose:

Plastic surgeons are often trained that the use of an alternate incision (AI) to the initial mastectomy incision at the time of staged tissue expander exchange for implant-based reconstruction (IBR) increases risk of ischemic complications due to interruptions of blood flow to the flap. However, there is a lack of data qualifying this assumption. Our study seeks to demonstrate that the use of an alternate incision in staged reconstruction is safe.

Methods:

A retrospective review of patients undergoing staged IBR from 2018-2024 at Rush University Medical Center by a single surgeon (DS) was completed. Patients were stratified into three groups based on incision used for expander exchange to permanent silicone gel implant also known as Stage 2. Information regarding patient comorbidities, surgical details, complications, and revisional procedures were collected.

Results:

A total of 153 patients and 283 breasts were included in the review with 117 breasts utilizing an alternate incision and 166 utilizing the same incision (SI), further subdivided into nipple sparing mastectomy (NSM) with 81, and goldilocks wise pattern (GWP) with 85. Total complications occurred in 4 (3.4%) AI breasts, 2 (2.5%) NSM and 2 (2.4%) GWP (p=1.0). These included infection (2 AI), implant malposition (2 AI), hematoma ( 2 NSM) and wound dehiscence (2 GWP). No ischemic complications were noted in any group (Table 1).

Conclusion:

There is not an increased risk of complications, in particular ischemic complications, when AI is used for staged reconstruction. Furthermore, breast projection was preserved and aesthetic outcomes improved with this technique