A 32-year-old female with a strong family history of breast cancer was diagnosed with multifocal invasive HER2-positive cancer of the right breast. She completed neoadjuvant chemotherapy and underwent bilateral skin-sparing mastectomy with right sentinel lymph node biopsy. Given the high likelihood of postoperative radiotherapy, immediate alloplastic breast reconstruction with bilateral tissue expanders (TEs) was performed. A 550cc expander was placed in each breast, initially filled to 450cc intraoperatively.
The patient was followed up weekly in the Plastic and Reconstructive Surgery Outpatient Clinic, where bilateral expanders were gradually expanded to 500cc. However, one week after expansion, she noted a reduction in volume of the left breast. An ultrasound later confirmed an extra-capsular rupture of the left breast tissue expander.
One month after the rupture, she underwent surgical replacement of the expander. Intraoperative examination of the prosthesis revealed a small puncture hole on the anterosuperomedial aspect of the expander, corresponding to the location of several surgical clips, more than 8cm away from the port. There was no evidence of peri-port puncture. The rupture was attributed to erosion from intravascular surgical ligaclips. All exposed or visible clips in the region were removed, and a new expander of the same type was placed and filled to 400cc intraoperatively. To maintain symmetry, the contralateral expander was deflated by 100cc. The patient continues to be closely followed during postoperative radiotherapy to the right breast.
This case highlights a rare but important complication of breast tissue expanders. While TE rupture has been previously associated with seroma, infection, cellulitis, and iatrogenic puncture, surgical clip-induced rupture has not been reported in the literature. This case underscores the need for vigilance in breast reconstruction, particularly regarding the placement of surgical ligaclips. Awareness of this potential complication can inform intraoperative technique and postoperative monitoring to minimize the risk of expander failure.