"Becker" Breast Tissue Expander/Implant

BAPRAS / 144 with  BAPRAS / 388/ 389

1985

What Is This Device?

Manufactured by Mentor from the USA, this is a breast implant comprising a smooth silicone elastomer shell, forming an outer membrane around a pocket of silicone gel. This itself surrounds an inner membrane which can be variably filled with saline. The implant would normally be placed in a space developed under the skin and pectoralis major muscle (sub-pectoral pocket). The inner membrane is inflated via a fill tube attached to a domed injection port, or reservoir, sometimes referred to as an “injection dome”. This sits immediately under the skin in a small pocket made away from the main implant. It is designed to be self-sealing and safely injected at intervals, as an outpatient, usually a week apart. This enables skin stretching, or "expansion".

The port/reservoir on this device is attached with a sealed clip, an up-to-date modification to the original design (see below BAPRAS/388). An even later modification reduced the size of the port (see below BAPRAS 389). This increased patient comfort. In all versions, both tube and port are detachable from the implant by traction once filled by the desired quantity of saline. This would be done during a smaller, second

procedure, after about 6-8 weeks using local anaesthesia .

Diameter 130mm, pre-inflation height 20mm

What Does It Do?

This implant was described by Becker in 1985 (Plastic and Reconstructive Surgery 79(4):p631-637, April 1987) to combine the properties of tissue expanders with both gel and saline filled breast implants. It could be used for immediate, or delayed breast reconstruction following mastectomy, congenital breast abnormality reconstruction or simple breast augmentation. Its utility was to act as a tissue expander, stretching skin at the site of a mastectomy to make a breast shape, but remain in place as a permanent implant. A simple expander would have to be removed and replaced with a dedicated implant at a second operation. Graduated inflation also avoided excessive tension on mastectomy wounds and achieved better symmetry or size-matching with the opposite breast. It could also be used under a latissimus dorsi myocutaneous flap breast reconstruction, the gradual expansion avoiding compromise of its circulation.

Significance To Plastic Surgery

Hilton Becker first described his “Inflatable breast implant with detachable reservoir” for breast reconstruction following cancer in December 1982 (Plastic and Reconstructive Surgery. 73(4):678-683, April 1984). It was a modification of a Heyer-Schulte inflatable breast implant and a single lumen design filled only with saline. He further described the expandable saline-gel implant in 1985 as a means to aesthetically augment breasts. However, this saline-gel version became popular as a method of delayed breast reconstruction (some months following mastectomy) in the UK in the late 1980s and 90s.

Today both technique and implant have been superseded by tissue expanders which are anatomically shaped (greater projection from the chest at the base) and which have integrated, not separate, fill ports.