{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T10:03:52Z","timestamp":1784628232950,"version":"3.55.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Surgical possibilities and implant options in reconstructive and corrective breast surgery have expanded considerably, making comparative outcome data essential for informed preoperative decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study was to present and compare a single surgeon's long-term experience with the Becker expander and fixed-volume implants in a large patient series, supplemented by a systematic review of the literature on postoperative and long-term complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The records of 183 patients (247 implants) who underwent reconstructive or corrective breast surgery with fixed-volume or Becker expander implants in a single-surgeon setting were retrospectively reviewed. Patient characteristics, risk factors, and surgical indications were analyzed within each implant group. Complications were categorized as minor or major, the latter defined as any event leading to revision surgery and implant loss. Results were compared to other large (n &amp;gt; 100) retrospective studies identified through a PubMed literature review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Cohorts of 90 patients with 112 Becker expander implants and 93 patients with 135 fixed-volume implants were compared. These groups did not differ significantly in patient history or risk factors. Complications were documented over a minimum follow-up of 24\u2005months (median, 5.87\u2005years). Overall complication rates did not differ significantly between groups (31.25% vs 32.59%, P \u2265 .05). Major complications leading to implant loss were significantly more frequent in the Becker group (9.73% vs 2.21%, P &amp;lt; .05), although this difference could not be reproduced in any individual subgroup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite the higher rate of major complications, overall complication rates in both groups were lower than average rates reported in the literature. Becker expanders remain a valid alternative to fixed-volume implants in single-stage reconstruction when patient selection is made carefully and aesthetic expectations favor volume adjustability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence: 3 (Therapeutic)<\/jats:title>\n                    <jats:p>For image description, please refer to the figure legend and surrounding text.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/asj\/sjag106","type":"journal-article","created":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T11:41:30Z","timestamp":1781955690000},"source":"Crossref","is-referenced-by-count":0,"title":["Becker Expander Versus Fixed-Volume Breast Implant: A Single-Surgeon Multicenter Evaluation of Becker Expanders and Literary Review"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9874-6198","authenticated-orcid":false,"given":"Laura","family":"Paul","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Frowein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Brunnert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5693-3120","authenticated-orcid":false,"given":"Wolfram","family":"Malter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8005-5639","authenticated-orcid":false,"given":"Philipp","family":"Wiebringhaus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Hirsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Warm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0675-8202","authenticated-orcid":false,"given":"Christian","family":"Eichler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"2026072105462011700_sjag106-B1","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1176\/ajp.142.1.40","article-title":"The sooner the better: a study of psychological factors in women undergoing immediate versus delayed breast reconstruction","volume":"142","author":"Schain","year":"1985","journal-title":"Am J Psychiatry"},{"key":"2026072105462011700_sjag106-B2","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1097\/00006534-198404000-00018","article-title":"The psychological impact of immediate breast reconstruction for women with early breast cancer","volume":"73","author":"Stevens","year":"1984","journal-title":"Plast Reconstr Surg"},{"key":"2026072105462011700_sjag106-B3","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1097\/00006534-199807000-00008","article-title":"Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer","volume":"102","author":"Slavin","year":"1998","journal-title":"Plast Reconstr Surg"},{"key":"2026072105462011700_sjag106-B4","first-page":"17","article-title":"The oncologic risks of skin preservation at mastectomy when combined with immediate reconstruction of the breast","volume":"172","author":"Kroll","year":"1991","journal-title":"Surg Gynecol Obstet"},{"key":"2026072105462011700_sjag106-B5","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1097\/00006534-199908000-00015","article-title":"Local recurrence risk after skin-sparing and conventional mastectomy: a 6-year follow-up","volume":"104","author":"Kroll","year":"1999","journal-title":"Plast Reconstr Surg"},{"key":"2026072105462011700_sjag106-B6","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1007\/s00268-012-1450-2","article-title":"The evolution of breast reconstruction: a historical perspective","volume":"36","author":"Champaneria","year":"2012","journal-title":"World J Surg"},{"key":"2026072105462011700_sjag106-B7","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1308\/rcsann.2020.0003","article-title":"The history and development of breast implants","volume":"102","author":"Perry","year":"2020","journal-title":"Ann R Coll Surg Engl"},{"key":"2026072105462011700_sjag106-B8","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1097\/00006534-198202000-00001","article-title":"Breast reconstruction after mastectomy using the temporary expander","volume":"69","author":"Radovan","year":"1982","journal-title":"Plast Reconstr Surg"},{"key":"2026072105462011700_sjag106-B9","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1097\/00006534-198404000-00031","article-title":"Breast reconstruction using an inflatable breast implant with detachable reservoir","volume":"73","author":"Becker","year":"1984","journal-title":"Plast Reconstr Surg"},{"key":"2026072105462011700_sjag106-B10","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1097\/00006534-198704000-00023","article-title":"The expandable mammary implant","volume":"79","author":"Becker","year":"1987","journal-title":"Plast Reconstr Surg"},{"key":"2026072105462011700_sjag106-B11","first-page":"519","article-title":"The permanent tissue expander","volume":"14","author":"Becker","year":"1987","journal-title":"Clin Plast Surg"},{"key":"2026072105462011700_sjag106-B12","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1097\/00007611-198702000-00004","article-title":"Immediate breast reconstruction after mastectomy using a permanent tissue expander","volume":"80","author":"Becker","year":"1987","journal-title":"South Med J"},{"key":"2026072105462011700_sjag106-B13","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.bjps.2018.10.030","article-title":"Immediate breast reconstruction in high-risk cases using an anatomically shaped permanent expandable implant","volume":"72","author":"Kedar","year":"2019","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2026072105462011700_sjag106-B14","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1097\/SAP.0000000000000232","article-title":"Risk factors associated with complication rates of Becker-type expander implants in relation to implant survival: review of 314 implants in 237 patients","volume":"75","author":"Taboada-Suarez","year":"2015","journal-title":"Ann Plast Surg"},{"key":"2026072105462011700_sjag106-B15","doi-asserted-by":"publisher","first-page":"345e","DOI":"10.1097\/PRS.0b013e31829ace7a","article-title":"The natural history of Becker expandable breast implants: a single-center 10-year experience","volume":"132","author":"Sindali","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"2026072105462011700_sjag106-B16","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1016\/j.breast.2012.03.007","article-title":"Breast reconstruction using permanent Becker expander implants: an 18 year experience","volume":"21","author":"Goh","year":"2012","journal-title":"Breast"},{"key":"2026072105462011700_sjag106-B17","doi-asserted-by":"publisher","first-page":"1300","DOI":"10.1016\/j.bjps.2009.07.004","article-title":"Becker expander implants: truly a long term single stage reconstruction?","volume":"63","author":"Chew","year":"2010","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2026072105462011700_sjag106-B18","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1016\/s0007-1226(96)90001-6","article-title":"A review of 120 Becker permanent tissue expanders in reconstruction of the breast","volume":"49","author":"Camilleri","year":"1996","journal-title":"Br J Plast Surg"},{"key":"2026072105462011700_sjag106-B19","doi-asserted-by":"publisher","first-page":"1790","DOI":"10.1097\/PRS.0b013e3181bf80aa","article-title":"Independent risk factors for infection in tissue expander breast reconstruction","volume":"124","author":"Francis","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"2026072105462011700_sjag106-B20","first-page":"173","article-title":"An audit of outcome including patient satisfaction with immediate breast reconstruction performed by breast surgeons","volume":"80","author":"Berry","year":"1998","journal-title":"Ann R Coll Surg Engl"},{"key":"2026072105462011700_sjag106-B21","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1097\/00006534-199504000-00013","article-title":"Rapid versus slow tissue expansion for breast reconstruction: a three-year follow-up","volume":"95","author":"Wickman","year":"1995","journal-title":"Plast Reconstr Surg"},{"key":"2026072105462011700_sjag106-B22","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1097\/00006534-199205000-00010","article-title":"Analysis of risks and aesthetics in a consecutive series of tissue expansion breast reconstructions","volume":"89","author":"Cohen","year":"1992","journal-title":"Plast Reconstr Surg"},{"key":"2026072105462011700_sjag106-B23","first-page":"227","article-title":"Ultra-conservative skin-sparing \u2018keyhole\u2019 mastectomy and immediate breast and areola reconstruction","volume":"82","author":"Peyser","year":"2000","journal-title":"Ann R Coll Surg Engl"},{"key":"2026072105462011700_sjag106-B24","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1097\/00000658-199705000-00013","article-title":"Skin-sparing mastectomy. Oncologic and reconstructive considerations","volume":"225","author":"Carlson","year":"1997","journal-title":"Ann Surg"},{"key":"2026072105462011700_sjag106-B25","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000003385","article-title":"Comparing surgical site occurrences in 1 versus 2-stage breast reconstruction via federated EMR network","volume":"9","author":"Singh","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2026072105462011700_sjag106-B26","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1097\/PRS.0000000000002428","article-title":"Is single-stage prosthetic reconstruction cost effective? A cost-utility analysis for the use of direct-to-implant breast reconstruction relative to expander-implant reconstruction in postmastectomy patients","volume":"138","author":"Krishnan","year":"2016","journal-title":"Plast Reconstr Surg"}],"container-title":["Aesthetic Surgery Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/asj\/advance-article-pdf\/doi\/10.1093\/asj\/sjag106\/68589822\/sjag106.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/advance-article-pdf\/doi\/10.1093\/asj\/sjag106\/68589822\/sjag106.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T09:46:30Z","timestamp":1784627190000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/asj\/advance-article\/doi\/10.1093\/asj\/sjag106\/8714968"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":26,"URL":"https:\/\/doi.org\/10.1093\/asj\/sjag106","relation":{},"ISSN":["1090-820X","1527-330X"],"issn-type":[{"value":"1090-820X","type":"print"},{"value":"1527-330X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]},"article-number":"sjag106"}}