Two-Stage Prosthetic Breast Reconstruction With Integrated Versus Remote Port Expanders: A Comparison of Complication Rates

Background: Ever since their introduction, tissue expanders for breast reconstruction have undergone a gradual evolution from remote port expanders to the integrated port expanders commonly in use today. Integrated port expanders have been widely adopted because of their ease of use and reliability, and though the convenience of integrated port expanders over remote port expanders is clear, a side-by-side comparison of complications has not been performed. A same-surgeon, same-institution study was conducted comparing the complication rates of remote versus integrated tissue expanders. Methods: A retrospective review was conducted of 107 patients who underwent breast reconstruction with tissue expanders. Remote tissue expanders were used in 21 consecutive patients (n = 42) and integrated port tissue expanders in 86 consecutive patients (n = 128). Patients who had received prior or concurrent breast irradiation were excluded from the study. Overall complications were compared, followed by complications that were broken down according to mechanical and infectious complications. Results: Fisher's exact test demonstrated a statistically significant increase in the rate of overall complications in remote port expanders compared with integrated port expanders (19% vs 7%; P = .024). Similarly, a statistically significant difference in the rate of mechanical complications between the 2 groups was found (7% in remote vs 0.8% in integrated, P = .047). When the rates of infectious complications were compared between the 2 groups, however (12% in remote vs 6% in integrated), no significant difference could be found (P = .312). Conclusion: In this retrospective review of prosthetic breast reconstructions, increased overall complications were observed with remote tissue expanders that were mainly mechanical in nature. The higher rate of infection observed in the remote port group was not statistically significant. Our study shows that remote port expanders do in fact have a higher complication rate than integrated port expanders. This should be taken into account when considering the use of remote port expanders in certain clinical scenarios.