Risk Factors of Tissue Expander Malposition in Two-Stage Breast Reconstruction

Background Tissue expander (TE) malposition is a notable complication in two-stage breast reconstruction, potentially leading to breast asymmetry and diminished patient satisfaction. Smooth-surface TEs are hypothesized to be more susceptible due to reduced tissue adherence. This study aimed to determine the incidence and risk factors associated with TE malposition and to discuss potential preventative strategies and corrective techniques. Methods A retrospective cohort study was conducted, reviewing data from 32 consecutive patients who underwent TE breast reconstruction at Mie University Hospital (Japan) between January 2020 and December 2021. The study collected demographic characteristics, surgical details, TE parameters, and injection volumes. Statistical analysis was performed using SPSS (ver. 29.0) to identify significant risk factors for TE malposition. Results The overall incidence of TE malposition was 9.4% (3/32). Statistical analysis revealed that younger age (39.7 ± 0.64 years vs. 49.9 ± 7.29 years, p < 0.001), the use of inframammary fold (IMF) plasty (33.3% vs 3.4%; p = 0.04), larger TE size, and higher initial injection volume (253.3 ± 128.6 ml vs. 130.7 ± 69.3 ml, p = 0.01) were significantly associated with TE malposition. Regression analyses identified younger age (p = 0.039) and larger TE size (p = 0.004) as independent predictors of TE malposition. Conclusions Younger age, the application of IMF plasty, larger TE size, and higher first injection volume are significant risk factors for TE malposition in two-stage breast reconstruction. These findings may inform surgical decision-making and postoperative care, potentially reducing the incidence of TE malposition.