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A 51-year-old lady underwent delayed two-stage right breast reconstruction following
right mastectomy with radiotherapy, 2 years previously. A McGhan® 133LV 500 cc (Inamed Aesthetics, Allergan Inc, CA, USA) low height biodimensional
tissue expander with integrated-valve was inserted subcutaneously with no intraoperative
saline inflation. Postoperatively, after the fourth saline inflation the implant was
leaking and was subsequently removed. A hole was found through the full thickness
of the implant 5 mm from the edge of the lower pole. We noted that the uninflated lower pole folds
over the implant back plate in such a way that the lower pole then approximates the
filling port. When the empty implant is placed in situ, tucked up against the lower
edge of the pocket at the level of the inframammary fold, the lower pole may overlay
the lower edge of the filling port. Subsequent percutaneous expansion may therefore
inadvertently catch the lower pole of the implant (Fig. 1). We would therefore advocate care when placing these uninflated devices to avoid
this problem.
Figure 1Image showing how the non-inflated tissue expander tends to fold at the inferior pole
and the passage the needle must have taken to create the two punctures.
