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Pre-pectoal Dual Port Tissue Expander Placement: No More Suction Drains?
Philipp Franck, MD.
New York Presbyterian, New York, NY, USA.

BACKGROUND: The most common way of reconstructing the female breast following mastectomy is using tissue expanders. Seromas are a common sequela from the initial operation and therefore closed suction drains are routinely placed during the initial surgery [Vardanian et al]. Drains however are associated with increased pain and discomfort for the patient some authors suggest increased infections rates [Degnim et al, Saratzis et al]. We report on our experience using a dual chamber tissue expander placed in the pre-pectoral space that allows drainage of periprosthetic fluid and avoids additional drain placement.
METHODS: A retrospective, single institution review of patientsí records was performed for all patients who underwent pre-pectoral tissue expander placement between January 2018 and June 2019. Excluded were patients who had additional drains placed or who underwent autologous reconstruction in combination with expander placement. 29 Patients were selected with a total of 51 expander placements. Demographics including body mass index, comorbidities, history of smoking or steroid use, perioperative chemo and radiation therapy as well as intraoperative details and indications for surgery were retrospectively collected. Outcomes were separated into minor and major complications. Major complications were defined as complications that required surgical intervention.
RESULTS: 51 tissue expanders were placed pre-pectoral without the use of additional closed suction drains. 24 patients underwent NSME (82.8%) and 5 patients underwent SSME (17.2%). 22 mastectomies were performed bilateral (86.3%) and all mastectomies had sentinel lymph nodes biopsies performed. Tumor pathology was DCIS in 13 patients (44.8%), IDC in 9 patients (31%), LCIS in 3 patients (10.3%) and BRCA positive gene status in 2 patients (6.9%). Overall complication rate was 27.6% of which 4 patients had major complications requiring return to the OR for expander removal (13.8%). 3 patients developed infections that required treatment with antibiotics (10.3%). All patients with infections ultimately required to have their expanders removed. Median follow up was 103 days.
CONCLUSIONS: Immediate breast reconstruction using a dual chamber tissue expander offers a drain free alternative to the immediate implant-based breast reconstruction. Our infection rate with 10.3% is lower than our own reported rates with subpectoral tissue expander reconstruction using either ADM or P4HB (17% and 11%). The overall complication rate is similar to historic data associated with breast reconstruction following mastectomy and suggests that dual chamber expander placement offers a safe alternative possibly decreasing the patients postoperative pain and discomfort that often is associated with closed suction drains [Saratzis et al].


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