Breast Cancer

, Volume 26, Issue 4, pp 446–451 | Cite as

Quantitative assessment and risk factors for chest wall deformity resulting from tissue expansion for breast reconstruction

  • Takaya MakiguchiEmail author
  • Daisuke Atomura
  • Hideharu Nakamura
  • Takaaki Fujii
  • Satoshi Yokoo
Original Article



Chest wall deformity after tissue expansion for breast reconstruction is less recognized than complications such as infection, hematoma, skin necrosis and capsular contracture. However, the condition should not be discounted because pain, rib fracture and dyspnea may occur in severe cases. The aim of this study is to evaluate the extent of chest wall deformity quantitatively using computed tomography (CT) and to identify risk factors for this condition after tissue expansion.


The subjects were 34 patients who underwent unilateral two-stage reconstruction and were examined by multidetector-row CT before expander surgery and during maximal tissue expansion. Chest wall deformity was assessed quantitatively using the Chest Wall Deformity Index (CWDI), which was measured before expander surgery (pre-CWDI) and during maximal tissue expansion (post-CWDI). Post minus pre (post−pre) CWDI was used as the index of chest wall deformity in the assessment of risk factors.


Post-CWDI was significantly higher than pre-CWDI (3.66 ± 3.23% vs. 0.03 ± 2.74%, P < 0.001 by paired t test), showing that chest wall deformity occurred after maximum expansion. In a multiple linear regression model, capsular contracture emerged as a significant predictor of increased post−pre CWDI (P = 0.003). BMI was a significant predictor of decreased post−pre CWDI (P = 0.003), but this result may have been due to the measurement method.


Our findings suggest that chest wall deformity is common after maximum tissue expansion for breast reconstruction. Awareness of the possibility of chest wall deformity during tissue expansion is important, particularly in cases with capsular contracture.


Chest wall deformity Breast reconstruction Computed tomography Capsular contracture Expander 


Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists. Funding was from institutional sources only.


  1. 1.
    Sinow JD, Halvorsen RA Jr, Matts JP, Schubert W, Letourneau JG, Cunningham BL. Chest-wall deformity after tissue expansion for breast reconstruction. Plast Reconstr Surg. 1991;88:998–1004.CrossRefGoogle Scholar
  2. 2.
    Moor EV, Wexler MR, Bar-Ziv Y, Weinberg A, Chaouat M, Ad-El D, et al. Chest wall deformity following maximal tissue expansion for breast reconstruction. Ann Plast Surg. 1996;36:129–32.CrossRefGoogle Scholar
  3. 3.
    Dickson MG, Sharpe DT. The complications of tissue expansion in breast reconstruction: a review of 75 cases. Br J Plast Surg. 1987;40:629–35.CrossRefGoogle Scholar
  4. 4.
    McKinney P, Edelson R, Terrasse A, Zukowski M. Chest-wall deformity following soft-tissue expansion for breast reconstruction. Plast Reconstr Surg. 1987;80:442–4.CrossRefGoogle Scholar
  5. 5.
    Cherubino M, Scamoni S, Maggiulli F, Floridi C, Mangini M, Di Giovanna D, et al. Breast reconstruction by tissue expansion: what is the integrity of the chest wall? J Plast Reconstr Aesthet Surg. 2016;69:e48–54.CrossRefGoogle Scholar
  6. 6.
    de Wildt RP, Tuinder S, van der Hulst RR. Substantial chest-wall deformity following tissue expansion after radiotherapy. Eur J Plast Surg. 2009;32:337–40.CrossRefGoogle Scholar
  7. 7.
    Sariguney Y, Ayhan S, Eryilmaz T. Chest wall deformity after tissue expansion. Scand J Plast Reconstr Surg Hand Surg. 2008;42:108–9.CrossRefGoogle Scholar
  8. 8.
    Kajikawa A, Ueda K, Tateshita T, Katsuragi Y. Breast reconstruction using tissue expander and TRAM flap with vascular enhancement procedures. J Plast Reconstr Aesthet Surg. 2009;62:1148–53.CrossRefGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2019

Authors and Affiliations

  • Takaya Makiguchi
    • 1
    Email author
  • Daisuke Atomura
    • 1
  • Hideharu Nakamura
    • 1
  • Takaaki Fujii
    • 2
  • Satoshi Yokoo
    • 1
  1. 1.Department of Oral and Maxillofacial Surgery, and Plastic SurgeryGunma University Graduate School of MedicineMaebashiJapan
  2. 2.Department of General Surgical ScienceGunma University Graduate School of MedicineGunmaJapan

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