Prosthetic breast reconstruction looks “simple” until you chase symmetry, fight the inframammary fold, and add radiation into the mix. This episode is a practical walkthrough of the two-stage expander–implant pathway—what actually matters, what fails, and how to plan it cleanly.

Episode overview
We cover patient selection, immediate vs delayed timing, modern biodimensional expanders, the expansion protocol, and the exchange operation with an emphasis on IMF positioning, inferior pole projection/ptosis, and strategies to optimize symmetry. We also break down ADM use (what it helps, what it costs), and why radiation changes complication risk and revision rates.

Key takeaways:

• Ideal implant candidates: thin, bilateral, or thin unilateral with a nonptotic contralateral breast.

• Expansion pearls: start ~10–14 days, fill 30–120 mL per visit; overexpand ~25–30% to build skin for ptosis/projection.

• ADM: enables larger initial fills and pocket control, but can increase seroma and infection-related failure.

• Exchange: measure base width/height/projection; IMF definition is the highest-leverage step.

• Radiation: higher capsular contracture/complication rates—plan sequencing and counsel hard.

Links
Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA
YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO
📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ
Apple: https://podcasts.apple.com/us/podcast/plastics-in-prac
Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/
#PlasticSurgery #BreastReconstruction #Microsurgery #SurgicalEducation #Residency #TissueExpander #ImplantReconstruction #ADM #Oncoplastic #PRS

References:

1. Antony AK, McCarthy CM, Cordeiro PG, et al. Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions. Plast Reconstr Surg. 2010;125(6):1606-1614. PMID: 20517083.

2. Chen CM, Disa JJ, Sacchini V, et al. Nipple-sparing mastectomy and immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg. 2009;124(6):1772-1780. PMID: 19952633.

3. Cordeiro PG, Pusic AL, Disa JJ, et al. Irradiation after immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg. 2004;113(3):877-881. PMID: 15108879.

4. Preminger BA, McCarthy CM, Hu QY, Mehrara BJ, Disa JJ. Influence of AlloDerm on expander dynamics/complications in immediate TE/I reconstruction. Ann Plast Surg. 2008;60(5):510-513. PMID: 18434824.

   
   

   
   

   Disclaimer: This content is for educational purposes only and is not medical advice.