A 7-year experience with 171 consecutive immediate breast reconstructions by one surgeon using a textured integrated-valve tissue expander was reviewed. All patients were reconstructed in multiple stages using a temporary biodimensional tissue expander followed months later by a long term implant. There was one (0.6 percent) spontaneous expander deflation that was replaced. Two (1.2 percent) expanders were removed for infection, and one was removed electively. Fourteen patients (8 percent) had flaps as well as expanders. Initially, expanders were replaced with silicone gel-filled and round saline-filled implants. Later, expanders were replaced mostly with anatomically designed textured saline-filled implants. Of the 171 expanders, 139 were thus ultimately followed by such anatomic designs. Seven (4 percent) of the implants were replaced because of deflation over 7 years. Five patients were lost to follow-up during the expansion phase of their reconstruction. Thirteen percent of these reconstructions received local radiation either before, during, or after expansion. There were a total of five (2.9 percent) significant capsular contractures, with four of them occurring in radiated patients. Ninety-eight percent of a subgroup of 42 consecutively queried patients expressed satisfaction with their reconstruction, while only 2 percent of the queried patients were dissatisfied.