Does Initial Fill-type Matter? Comparing Complication Rates And Patient-reported Outcomes In Prepectoral Tissue Expanders Initially Filled With Air Versus Saline
Michelle Coriddi, MD, Ethan L. Plotsker, BA, Kathryn Haglich, MS, Robyn N. Rubenstein, MD, Jacqueline J. Chu, MD, Robert J. Allen, Jr., MD, Joseph H. Dayan, MD, Babak J. Mehrara, MD, Joseph J. Disa, MD, Jonas A. Nelson, MD, MPH.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
PURPOSE: Optimizing prepectoral tissue expander fill volume while minimizing stress on mastectomy skin flaps proves challenging. One option to decrease stress from expander weight is to utilize air initially, with subsequent exchange for saline during postoperative expansion. The purpose of this study was to compare air and saline as initial fill-types for patients undergoing two-stage implant-based reconstruction. We sought to characterize complications and early Patient Reported Outcomes (PROs) based on fill-type.
METHODS: A retrospective review of prepectoral tissue expander patients between 2018-2020 was performed. Fill-type utilization was assessed over time. The primary outcome was expander loss. Fischer's exact and student t-test were performed. PROs were assessed via BREAST-Q physical well-being of the chest 2 weeks postoperatively.
RESULTS: 560 patients (928 expanders) were included; 372 had air-filled devices (623 total expanders) while 188 had saline-filled devices (305 total expanders). No differences were observed for overall rates of loss (5.3% vs. 2.9%, p=0.33) or rates of full-thickness mastectomy skin flap necrosis requiring revision (2.4% vs. 1.3%, p=0.330). Air-filled expanders were associated with higher rates of seroma (9.8% vs. 5.9%, p=0.046). No meaningful difference in BREAST-Q physical wellbeing of the chest was observed (p=0.142). A substantial decrease in utilization of air occurred over the last year.
CONCLUSION: Tissue expanders initially filled with air appear to confer no significant advantage in terms of maintaining mastectomy skin flap viability or PROs and may be associated with higher seroma risk. These results provide new information that can guide choice of initial tissue expander fill-type.
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