Patient-subjective cosmetic outcomes following the varying stages of tissue expander breast reconstruction: The importance of completion

Donald W. Buck, Deana Shenaq, Kamaldeep Heyer, Caroline Kato, John Y.S. Kim*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Introduction: Tissue expander breast reconstruction consists of three major surgical steps: placement of the expander after mastectomy, exchange of the expander for an implant, and nipple-areola complex reconstruction. The evolution of patient satisfaction throughout this process has not been evaluated. Here we performed a stratified analysis of patient-subjective cosmetic outcomes during the stages of breast reconstruction. Methods: Twenty-eight consecutive tissue expander-implant reconstructions were performed by the senior author using human acellular dermis. Cosmetic outcomes were assessed after each reconstructive stage using a validated Breast Evaluation Questionnaire consisting of questions related to breast size, shape and firmness in three separate contexts: intimate or sexual activities, leisure or social activities, and professional or job-related activities. Results: Eighteen patients underwent unilateral reconstruction, while 10 underwent bilateral reconstruction. Satisfaction scores were statistically higher following Stage I and II procedures for bilateral reconstructions. For unilateral reconstructions, there was a statistically significant elevation in scores following Stage II. The addition of nipple-areola reconstruction resulted in the highest scores for both unilateral and bilateral reconstructions. These score elevations were significant (p < 0.05) in nearly every measured context for unilateral reconstructions and as such, the significant differences in scores between unilateral and bilateral cohorts after stages I and II were nearly eliminated after completion of the entire reconstructive process. Conclusion: Satisfaction with tissue expander reconstruction is significantly affected by the patients' stage during the reconstructive process. Completion of all three stages, including nipple-areolar complex reconstruction, achieves maximal patient satisfaction. For unilateral reconstructions, completion of the entire reconstructive process, including contralateral symmetry procedures and nipple-areolar complex reconstruction, results in cosmesis scores that are similar to those in bilateral cases.

Original languageEnglish (US)
Pages (from-to)521-526
Number of pages6
Issue number6
StatePublished - Dec 2010


  • Acellular dermis
  • Breast reconstruction
  • Cosmetic outcome
  • Patient satisfaction
  • Tissue expander

ASJC Scopus subject areas

  • Surgery

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