Reconstruction of a pendulous breast utilizing a tissue expander.

We have presented the evolution of our current methods of breast reconstruction, which utilize the tissue expander in a variety of ways. We strongly support the concept that expansion should occur in the subcutaneous layer of the lower thoracic region. It is, after all, the region occupied by a mature breast that has descended normally with age, or one that is relatively large in size. A tissue bank is created that places skin and subcutaneous tissue right where it is needed to ensure that the breast will not appear as a simple mound. The upper pole of the reconstruction has never been the problem in cases in which a relatively normal pectoral musculature has been left following mastectomy. Therefore, whether the expander and implant should be completely "submuscular" is no longer an issue holding back further developments in the field of breast reconstruction utilizing tissue expansion techniques.