ASO Author Reflections: Initial Tissue Expander Fill with Air Reduces Complications in Immediate Breast Reconstruction

Excerpt

Ischemic complications after mastectomy and immediate tissue expander-based breast reconstruction are common problems that can lead to unplanned healthcare utilization and costs.¹ The high complication rate also can lead to tissue expander explants, resulting in delays in receipt of definitive breast reconstruction.¹ Accordingly, strategies to reduce complications after tissue expander placement are highly sought after. Traditionally, tissue expanders are filled with saline at the time of mastectomy, then sequentially filled in clinic with saline until the final fill volume is reached before definitive reconstruction. Studies have demonstrated that higher initial fill volumes of saline at the time of mastectomy are associated with increased incidence of ischemic and overall complications.² Recently, the use of alternative fill mediums, such as carbon dioxide or air, have been proposed due to the lower weight and density of the gases compared with saline, which in turn theoretically exert less pressure on already-tenuous mastectomy skin flaps. However, to date, the effect of initial tissue expander fill with air on complication rates has only been examined in small, retrospective case series.^3,4 The purpose of this study was to assess the influence of initial tissue expander fill medium (air versus saline) on ischemic and overall complications in immediate tissue expander-based breast reconstruction by using a propensity-score matched model.⁵ …