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Breast reconstruction with implants has evolved dramatically since its introduction in the 1960s. While the earliest efforts relied on a single-stage placement of a permanent implant, modern approaches now emphasize tissue expansion over several weeks to months, followed by the exchange of a temporary implant for a permanent one. This method is one of the most commonly utilized reconstructive options after mastectomy, offering patients a relatively straightforward procedure that often adds little operative time to the initial cancer surgery. Expanders can be placed immediately at the time of mastectomy or in a delayed fashion, giving patients and clinicians flexibility in treatment planning. This activity reviews the indications, contraindications, and procedural steps involved in the use of tissue expanders in breast reconstruction. Learners also explore common complications, methods to improve surgical outcomes, and the latest strategies to optimize patient satisfaction. Through participation, members of the interprofessional team, including surgeons, oncologists, nurses, and allied health professionals, enhance their knowledge of reconstructive options, improve communication across disciplines, and strengthen collaborative decision-making. By completing this activity, learners gain a deeper understanding of the evolving role of tissue expanders in breast reconstruction. They also develop practical skills that can be applied in real-world clinical settings, ultimately improving competence, supporting patient-centered care, and ensuring safe, effective outcomes for individuals undergoing breast cancer surgery. Objectives: Assess the indications for breast reconstruction with tissue expansion and implant placement. Identify the complications of breast reconstruction with tissue expansion and implant placement. Evaluate the technique of breast reconstruction with tissue expansion and implant placement. Communicate the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients undergoing breast reconstruction with tissue expansion and implant placement. Access free multiple choice questions on this topic.

Breast reconstruction with synthetic implants was first introduced in the 1960s as a single-stage placement of a permanent implant at the time of mastectomy. This approach has evolved into a staged process, beginning with the placement of a tissue expander and gradual expansion over several weeks to months, followed by exchange with a permanent implant. Currently, this method is widely used for selected patients undergoing mastectomy because it is relatively straightforward and adds minimal operative time to the initial procedure. Expanders may also be placed after resection, with later conversion to a permanent implant. This delay allows for planned radiation therapy without significantly affecting reconstructive outcomes. Optimal results require close collaboration among surgeons, medical oncologists, and radiation oncologists to individualize treatment and support safe, patient-centered care.[1]

Complications of tissue expanders and implants are similar to those seen in cosmetic breast augmentation. Care must be taken intraoperatively to achieve hemostasis. Hematomas carry a high risk of infection and increase the likelihood of capsular contracture. Prompt evacuation of hematomas represents a surgical emergency because of the risk of loss of the overlying skin and soft-tissue envelope. Tissue expander and implant infection can lead to multiple procedures. Although rare and potentially devastating, implant removal and repeat placement may be required once the infection has resolved. Bleeding and infection occur with an incidence of 1% to 2%, respectively.[21] Skin flap necrosis resulting from overly aggressive inflation of tissue expanders can be devastating, and care must be taken to ensure adequate blood flow. Patient education is paramount, and any concern about persistent or unusually severe pain or a change in the color of the overlying skin warrants immediate examination and possible partial deflation of the expander. Long-term complications are frequent and range from minor to distressing, but typically do not jeopardize the ultimate success of the reconstruction. These complications include skin rippling, capsular contracture, infection, and implant rupture. Routine surveillance is required to monitor implants for delayed complications. Capsular contractures are fibrotic scars that form around the implant, representing an extreme example of a foreign body reaction. The scar causes tightening or displacement of the implant and may cause an abnormally firm and painful breast. Contractures are graded based on the Baker scale: Grade I: Normal, soft breast that appears natural in shape and size; no discernible capsule Grade II: Slightly firm implant with normal appearance Grade III: Contracture causes a firm and abnormal appearance Grade IV: Hard, distorted, and painful breast

Capsular contractures are fibrotic scars that form around the implant, representing an extreme example of a foreign body reaction. The scar causes tightening or displacement of the implant and may cause an abnormally firm and painful breast. Contractures are graded based on the Baker scale: Grade I: Normal, soft breast that appears natural in shape and size; no discernible capsule Grade II: Slightly firm implant with normal appearance Grade III: Contracture causes a firm and abnormal appearance Grade IV: Hard, distorted, and painful breast Surgical intervention should be considered for grades III and IV. Grades I and II may develop contractures; therefore, implants in these grades should be monitored more frequently.[22] A link exists between implants and T-cell anaplastic large-cell lymphoma. Although most studies are anecdotal, textured implants may be more closely associated, possibly related to the "salt-loss" technique, chronic inflammation, bacterial biofilm, or other unknown mechanisms. This risk is an emerging indication for breast implant removal, and research into etiology, risk factors, and treatment is ongoing. The incidence is estimated at approximately 1 in 2400 to 1 in 30,000, based on a series of over 3000 patients published in 2020 from Memorial Sloan-Kettering.[23]

Breast reconstruction with tissue expanders and implants represents an essential aspect of multidiscip linary breast cancer care, designed to restore physical form and contribute to psychological recovery following mastectomy. While the reconstructive surgeon is responsible for the technical execution of the procedure, optimal outcomes depend on coordinated contributions from the broader interprofessional team. Preoperative patient assessment, medical optimization, and counseling regarding the risks, benefits, and potential complications of reconstruction are critical steps that extend beyond the operating room. Interprofessional collaboration is integral to this process. Surgeons work in consultation with medical oncologists and radiation oncologists to ensure reconstructive timing aligns with cancer treatment protocols. Anesthesiologists contribute to perioperative planning, particularly for patients with significant comorbidities. Nursing staff facilitate perioperative support and patient instruction, while primary care clinicians address comorbidities, reinforce smoking cessation, and oversee long-term health. Rehabilitation specialists and survivorship counselors may also participate, offering strategies to improve functional recovery and psychosocial adjustment. Through shared decision-making, open communication, and recognition of the value of each discipline, the interprofessional team creates an environment that prioritizes patient safety and enhances clinical outcomes. This activity has been developed to strengthen interprofessional competence, with the overarching goal of equipping healthcare professionals across roles to anticipate complications, provide coordinated care, and collectively improve the reconstructive experience and long-term quality of life for patients undergoing breast cancer treatment.