Becker expander implants: truly a long term single stage reconstruction?

Despite being more expensive than conventional tissue expanders, Becker expanders offer the advantage of single stage breast reconstruction. However, the large series in published literature which report good outcomes of Becker expanders in breast reconstruction have a mean follow up period of less than three years. This does not allow for definitive conclusions as to whether the Becker expander truly meets its design goal of a lasting single stage breast reconstruction. This study is a retrospective case note review of all patients who underwent breast reconstruction using a Becker expander at our unit from 1993 to 1998, with a mean follow up of 12.5 years. Sixty-eight Becker-only breast reconstructions were carried out following oncological and risk-reducing mastectomies, and for congenital hypoplasias. There was a high premature overall explantation rate with 68% of expanders removed by 5 years due to complications which included poor aesthetics, capsular contracture and infection. The mean time to explantation for these patients was only 23 months, and time to 50% overall expander removal ('half life') was just 30 months. On subgroup analysis, patients in the congenital hypoplasias group had a significantly better rate of expander retention with 67% remaining in situ at 10 years. In comparison, patients in the oncological and risk-reducing mastectomy groups had implant retention rates of 2% and 7% respectively. The Becker expander does not appear to meet its design purpose of lasting single stage breast reconstruction in post-mastectomy cases. In contrast, it appears to have significantly better longevity when used for congenital hypoplasias.