Comparison of subcutaneous versus submuscular expander placement in the first stage of immediate breast reconstruction

Lin Zhu, Anita T. Mohan, Jad M. Abdelsattar, Zhen Wang, Aparna Vijayasekaran, Soyun M. Hwang, Nho V. Tran, Michel Saint-Cyr

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Background and Aim Tissue expander-based two-stage reconstruction remains the most commonly used technique in immediate breast reconstruction. This study compares the subcutaneous expander placement to the traditional submuscular placement and describes our early experience with the expander insertion plane-choosing algorithm. Methods A retrospective study of patients who underwent two-stage immediate breast reconstruction from May 2012 to October 2014 was conducted. All expander insertion planes were chosen using the same algorithm. Expansion, pain, and complications were compared between two groups. Results The study included 88 patients (158 expanders; 50 subcutaneous and 108 submuscular). The subcutaneous group had a higher intraoperative expansion ratio (p < 0.001), high first postoperative expansion ratio (p < 0.001), shorter duration of expansion (p = 0.02), less number of expansion visits (p = 0.002), and less average pain during admission (p = 0.004). Significant differences in the intraoperative and first postoperative expansion ratios in patients with postmastectomy radiation therapy were also found between the two groups (p = 0.005 and 0.01, respectively). Complications during expansion and after second-stage autologous flap reconstruction were comparable between two groups. Conclusion The subcutaneous expander placement was associated with greater intraoperative and first postoperative expansion, shorter expansion duration, less expansion visits, and less pain. With the expander insertion plane-choosing algorithm, subcutaneous expander placement could be performed with comparable complications rates with the submuscular placement during expansion and after second-stage autologous flap reconstruction. Further studies can be performed due to the lack of long-term complications following second-stage implant reconstruction in the subcutaneous approach.

Original languageEnglish (US)
Pages (from-to)e77-e86
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Issue number4
StatePublished - Apr 1 2016


  • Breast reconstruction outcome
  • Subcutaneous tissue expansion
  • Submuscular tissue expansion
  • Tissue expander
  • Two-stage immediate breast reconstruction

ASJC Scopus subject areas

  • Surgery


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