Reconstruction of a pendulous breast utilizing a shaped expander.

Can a breast-shaped skin envelope that is pendulous be formed through the use of a shaped expander? Once formed, can its shape be maintained following the exchange of the expander for a round implant? My colleagues and I set out to answer these questions by constructing a breast-shaped expander by altering a standard round expander. It was introduced through an inframammary incision while performing a Pennisi-Ryan type reconstruction. The expander was placed in a limited pocket beneath the pectoralis major muscle. The lower pole of the expander was left in the subcutaneous plane. The skin expanded into a mature, pendulous breast shape that exhibited a slight degree of ptosis. The shape was maintained following the exchange of the expander for a high-profile round implant. If contracture occurred, the distortion detracted from the initial pleasing shape. We present our experience with the first 15 reconstructions using this method. The best results were seen in delayed reconstruction cases. The method is of no value in cases of primary reconstruction. Lessons learned from this small series of cases are detailed, and complications are discussed. The follow-up for these patients is a minimum of one year from the beginning of expansion.