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A large personal experience with breast reconstruction using tissue expanders (149 patients with Radovans, and more than ISO patients with Beckers), with many suboptimal results especially in the early learning stages, has brought about changes in approach offering a much higher probability of acceptable breasts. This report attempts to combine multiple factors useful in yielding such results. Areas addressed include immediate versus delayed reconstruction, selection of candidates, selection of expander type, appropriate placement of expander at a site minimizing the requirement for pocket modification, choosing the optimal size expander, importance of maximal overexpansion to yield a good submammary fold, and means of determining adequate overexpansion to match an unmodified contralateral breast and the risks inherent in overexpansion. Timing, interval, and length of maintenance of hyperexpansion are described along with deflation and timing of port removal. Both the skate and star techniques of nipple and areolar reconstruction in the hyperexpanded patient yield very acceptable results despite thinned skin and minimal subcutaneous tissue. Good, satisfactory, and suboptimal clinical results will be presented. In our experience, tissue expansion reconstruction offers distinct advantages in a large majority of patients with the proviso that patients are willing to accept the time required for hyperexpansion and the waiting period for deflation.