Background: Tissue expansion is not widely accepted for reconstruction of breast and chest burn deformities because of concerns about the capacity of compromised skin to stretch without complications. The authors hypothesized that tissue expander reconstruction of breast and chest burn deformities is reliable and has outcomes similar to those of expansion of similar nonburned tissues. The authors used congenital breast anomalies as a control because they share similar reconstructive challenges: constricted skin envelope and gross malformation of the parenchyma and nipple-areola complex. The authors also hypothesized that endoscopic techniques may improve outcomes for breast and chest burn reconstruction. Methods: A retrospective review was completed of tissue expander reconstructions of burn and congenital breast deformities. All reconstructions used an endoscopic or open tissue expander placement and subsequent local tissue rearrangements. Data were analyzed using parametric and nonparametric methods. Results: For reconstruction of burn deformities, 15 women had 37 expanders placed. Within the congenital breast cohort, 20 patients had 22 tissue expanders placed. There were no statistical differences in follow-up time, body mass index, or comorbidities between burn and congenital patients. There was no statistical difference in major complications (p = 0.72) between these groups. Within the burn deformity cohort, endoscopic reconstructions had fewer major complications (p = 0.04), required less operative time per expander (p < 0.001), and required less time to expand (p = 0.021). Conclusions: The authors believe that breast and chest burn deformities can be safely reconstructed with tissue expanders without increased complications over expander reconstruction of the congenital breast. Furthermore, endoscopic techniques may be superior for burn deformities because of improved visualization and remote incisions.