Analyzing implant movement with tabbed and nontabbed expanders through the process of two-stage breast reconstruction

Background: Tabbed tissue expanders have the potential benefit of less migration during the expansion process, which may allow for more predictable outcomes. Despite this theoretical benefit, no study has critically evaluated the proposed advantage as compared with traditional nontabbed expanders. Therefore, the authors photographically analyzed the migration and movement of tabbed and nontabbed expanders throughout the reconstructive process. Methods: The authors performed a retrospective review of patients who underwent two-stage expander-to-implant reconstruction from 2010 to 2012. Standardized frontal photographs were used for analysis. Adobe Photoshop was used to measure the relative movement of each patient's expander from insertion until immediately before implant exchange and after implant exchange. Results: Forty-four breasts were analyzed. Migration was reduced significantly in all four directions for both the tissue expander and permanent implant stages of reconstruction. Medial, lateral, superior, and inferior migration of the tissue expander in the tabbed cohort was reduced by 59.5 percent (p = 0.001), 48.3 percent (p = 0.004), 53.4 percent (p = 0.0005), and 73.4 percent (p < 0.0001), respectively, compared with the nontabbed cohort. Likewise, medial, lateral, superior, and inferior migration of the permanent implant in the tabbed cohort was reduced by 44.3 percent (p = 0.049), 73.7 percent (p < 0.0001), 67.7 percent (p = 0.0008), and 61.0 percent (p = 0.003), respectively. Conclusions: Two-stage implant reconstruction allows for precision in implant placement after an appropriately placed expander. Tabbed expanders appear to maintain better positioning on the chest wall compared with nontabbed expanders during the expansion process, and may allow for more precise mound creation with the permanent implant.