Acellular dermis-assisted breast reconstruction with the use of crescentric tissue expansion: A functional cosmetic analysis of 40 consecutive patients

Background: Crescentric tissue expanders have the potential to improve postoperative aesthetic results via selective lower pole expansion; however, limited data are available on their efficacy. Objectives: The authors assess postoperative functional and cosmetic outcomes of acellular dermis-assisted breast reconstruction with crescentric tissue expansion. Methods: This study is a single-institution, retrospective review of 40 consecutive patients who underwent acellular dermis-assisted breast reconstruction with crescentric tissue expansion. Demographic data, operative details, and procedural outcomes were recorded and assessed. Cosmetic outcomes were assessed using the Breast Evaluation Questionnaire. Results: Fifty-eight breasts representing 36 bilateral and 22 unilateral reconstructions were analyzed. Of these, 45 (78%) underwent tissue expander (TE) to implant exchange. The mean interval between stage 1 and stage 2 was 92 ± 20 days, with a total follow-up time of 141 ± 16 days. The average intraoperative expander fill volume was 213.5 mL, with an average final fill of 285 mL (range, 180-740 mL). The average number of expansions was 1.6. Overall, there were five complications (8.6%). Eighty-three percent of patients participated in the breast evaluation questionnaire. Answers to each question were reported using a qualitative five-point scale that ranged from 1 (very dissatisfied ) to 5 (very satisfied). For the bilateral reconstructions, the average score in all contexts was 4.5 ± 0.3, 4.33 ± 0.5, and 4.36 ± 0.33 for size, shape, and firmness, respectively. For unilateral reconstructions, the average scores were 4.0 ± 0.58, 3.93 ± 0.38, and 4.13 ± 0.21, respectively. Conclusions: Crescentric expander-based reconstruction with acellular dermis assistance is well tolerated, especially in smaller breasted women. Functional and cosmetic outcomes were acceptable and comparable to previous reports of traditional expander-based reconstructions.