Addressing Congenital Breast Asymmetry Using 2-stage Breast Reconstruction With Tissue Expanders: A 22-year Single Institution Experience

Background: Congenital breast asymmetry can have significant adverse psychosocial sequelae for adolescent and young adult women. Although early surgical intervention is beneficial, commonly described techniques include immediate implant and autologous tissue transfer reconstruction. We describe and evaluate outcomes of our 22-year experience using tissue expanders before implant placement to maintain symmetry throughout breast development. Methods: A retrospective chart review analyzed patients with congenital breast asymmetry who completed 2-stage breast reconstruction from January 2000 to November 2022. Patients' demographic, clinical, surgical, and complication data are reported. Results: Thirty patients completed 2-stage breast reconstruction for congenital breast asymmetry. The most common diagnosis was Poland syndrome. Median age at initial presentation was 17 years. About 47% of patients received tissue expanders before 18 years of age, and 30% of patients received implants before 18 years of age. The median interval between tissue expander placement and implant placement was 351.5 days, with a median interval of 223 days between final tissue expander fill and implant placement. Median follow-up time after implant placement was 731.5 days. Adjunctive procedures were performed in 87% of patients and included contralateral mastopexy, contralateral augmentation, fat grafting, ipsilateral latissimus dorsi flap, and free nipple grafting. Major and minor complication rates were 27% and 43%, respectively. Conclusions: Two-stage breast reconstruction with tissue expansion is a viable option for patients with congenital breast asymmetry of various phenotypes. Complication rates were similar to those of other forms of breast reconstruction. Through serial expansion, this technique enables maintenance of breast symmetry throughout development.