Multicentric study on Breast Reconstruction outcome using Becker implants.

The use of tissue expanders and implants is the
simplest option for breast reconstruction following mastectomy.
In the 1980s, Hilton Becker introduced a round,
inflatable breast implant that could be used as a permanent
implant. Since then, the original implant has been
improved in both design and architecture. The new Becker
device consists of an anatomical implant composed of
35% cohesive silicone gel in the outer chamber and 65%
normal saline in the inner chamber. This multicenter study
describes our experience with the new anatomical Becker
implants in a large series of patients, in both immediate
and delayed breast reconstruction. We reviewed the clinical
records of 204 patients who underwent a breast
reconstruction with an anatomical Becker-type implant in
the sub-muscular position between November 2004 and
December 2006. Data on the patients’ characteristics,
indications for reconstruction, operative technique, device
size used, complications, and need for further operations
were collected and analyzed. A total of 248 breast
reconstructions were performed in 204 patients. One
hundred forty-three patients (70%) underwent an immediate
reconstruction; in the remaining 61 cases (30%), the
breast reconstruction was performed later. The patients’
age ranged from 26 to 66 years, with a median age of
47.5 years. The implant was placed unilaterally in 160
women (78.5%) and bilaterally in the remaining 44
(21.5%). Complications occurred in 85 cases (34.2%), in
both the immediate and delayed reconstruction groups, and
were related to wound healing, bleeding, seroma, and
problems with the inflatable expanders. Iatrogenic implant
rupture was documented in one case (0.4%). Inflation
was impossible in 7 cases (2.8%) as a result of valve
obstruction (3 cases, 1.2%) and valve displacement
(4 cases, 1.6%). Implant malposition was the most troublesome
complication; indeed, 34 patients (13.7%) complained
of device malposition. Capsular contracture was
assessed in all the patients. Significant capsular contracture
(Baker grade III and IV) was detected in 6 cases (2.4%) at
the follow-up approximately 1 year after surgery. Breast
reconstruction with permanent inflatable expanders is
widely acknowledged as a useful technique for breast
cancer patients undergoing simple or modified radical
mastectomy. The use of this device eliminates the need to
replace a temporary tissue expander with a breast implant,
thus avoiding a second operation. Although we believe
autologous tissues afford the best method of reconstruction
in the majority of patients, the results of our study show
that expander implant placement may yield a reasonable
reconstruction.