Ideas and Innovations: Successful Maintenance of Implant-Based Breast Reconstruction in Recurrent Breast Cancer Treatment Using Tailored Tissue Expander Conversion

Patients with a prior mastectomy and implant-based breast reconstruction (IBR) who suffer breast cancer recurrence generally require wide excision followed by chest wall radiotherapy for definitive treatment. This typically results in poor cosmetic outcomes due to skin/soft tissue deficit, progressive capsular contracture of the irradiated implant, deformity, and asymmetry despite otherwise successful oncologic treatment. We describe a novel staged approach using tissue expander (TE) at the time of recurrence treatment to maintain and optimize implant-based breast reconstruction outcomes. At the time of wide excision of recurrent cancer, our approach involves conversion of the existing implant into a TE with pocket revision and lowering, overexpansion of TE prior to radiotherapy, followed by TE exchange to an implant at least six months after radiotherapy. We reviewed five patients with recurrent breast cancer who underwent this staged approach to successfully maintain their IBR and optimize long-term cosmetic results. Following first-stage implant conversion to TE, one patient had axillary seroma in the setting of axillary lymph node dissection requiring drain placement, and one patient developed moderate post-radiotherapy capsular contracture which was successfully revised during the planned second-stage procedure. There were no complications following the second-stage TE exchange to implant procedure. Conversion of pre-existing implant to TE allows preservation of IBR and optimizes cosmetic result in the setting of recurrent breast cancer treatment. This staged approach can mitigate the known negative effects of radiotherapy and provide reliable maintenance of a controlled aesthetic outcome with implants.