Introduction: Breast reconstruction with tissue expansion and implants remains an important option for the post-mastectomy patient. We undertook a review of 82 two stage breast reconstructions in 62 consecutive patients by a single surgeon using the McGhan LV (low height) expander and the McGhan 363 LF (low height) breast implant.

Methods: The medical records of 62 consecutive breast reconstruction patients undergoing 82 two stage breast reconstructions by a single surgeon were reviewed.

Results: Sixty two patients underwent 82 breast reconstructions from 2000-2006 by a single surgeon using the McGhan LV expander and the McGhan 363 LF implant. The average age was 54 years(range 24-82 years). Fifty three (65%) were immediate reconstructions and 29 (35%) were delayed reconstructions. For the delayed procedures the interval from mastectomy to expander placement was 26 months (range 2.5 months-9 years). Thirty seven reconstructions (45%) were for Stage I breast cancer; 21 reconstructions (26%) were for Stage II breast cancer; 17 reconstructions (21%)were prophylactic mastectomies with contralateral breast cancer; 6 reconstructions (7%) were prophylactic for 3 patients with BRACA + gene; and one reconstruction (1%) for Stage III breast cancer. Twenty three patients (37%) received adjuvant chemotherapy; 6 patients received chemotherapy during the expansion process. No reconstructions were performed on previously irradiated breasts, however two patients received radiation therapy to the fully filled expander prior to implant placement. The expansion interval averaged 4.5 months (range 2-15 months). The total reconstruction time (expander placement to nipple reconstruction) averaged 10 months (range 5-32 months). Five patients chose not to undergo nipple reconstruction. Early complications (before completion of the reconstruction) occured in 6% of cases including one expander infection and one implant infection, both necessitating conversion to latissimus dorsi flap reconstruction. Two patients developed cellulitis during the expansion process resolving with po antibiotics. In one patient the expander was inadvertently punctured with a needle during the expansion process. She subsequently underwent successful implant placement. Late complications (following completion of the reconstruction) included 6 patients (7.3%) who underwent treatment for asymmetry with implant exchange; 5 patients (6%) who underwent free fat transfer (Coleman system) for superior perimeter defects; and 3 patients (3.6%) who underwent replacement for implant deflation.

Conclusion: Two stage breast reconstruction with the McGhan LV expander and the McGhan 363 LF implant gives excellent results with low morbidity and reduced recovery time.
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