Combined Autologous and Prosthetic Breast Reconstruction: Defining the Upper Limits of Safe Expansion in Obesity

Background Combined latissimus dorsi and prosthetic reconstruction is a useful reconstructive option in patients with a history of breast radiation who are not good candidates for abdominally based autologous reconstruction. One difficulty, particularly in obese patients, is that the thickness of the flap can impair port localization, increasing the risk of inadvertent puncture during expansion. The authors sought to investigate the upper limits of tissue thickness at which tissue expansion can be reliably performed. Methods A cadaveric study was designed in which 2 blinded observers attempted to localize the port of a Mentor CPX-4 expander under tissue 1, 2, 3, 4, 5, and 6 cm thick. Thirty attempts were made per tissue thickness. Results For tissue thicknesses of 1 to 4 cm, the success rate was 100% (k = 1). At 5 cm, the success rate decreased to 86.6% (k = 1); at 6 cm, 43.3% (k = 0.85). Point biserial correlation revealed a negative correlation between tissue thickness and accuracy at a thicknesses of greater than 4 cm (r = −0.55, P 4 cm), Fisher exact test revealed a statistically significant difference between these 2 populations (P