Prepectoral Two-Staged Breast Reconstruction with Carbon-Dioxide Tissue Expansion
Franca Kraenzlin, Medical Doctor, Karan Chopra, MD, Halley Darrach, MD MBA, Gedge Rosson, MD, Kristen Broderick, MD, Oluseyi Aliu, MD MS, Justin Sacks, MD MBA.
Johns Hopkins, baltimore, MD, USA.
BACKGROUND:
Roughly 80% of patients undergoing mastectomy in the Unites States opt for reconstruction with prosthetic implants. The introduction of acellular dermal matrices (ADM) has allowed for placement of breast prostheses in the prepectoral plane, while a new carbon-dioxide tissue expander (AeroForm) allows for needle-free, patient-controlled expansion. These two novel technologies have ushered in a new patient-centered era of breast reconstruction, with the possibility of reducing patient morbidity for the first time in decades. We hypothesize that AeroForm expanders placed in the prepectoral plane reduce time to second-stage reconstruction, reduce the number of clinic visits, and have lower complications than traditional saline tissue expanders (TE).
METHODS: This is a retrospective review of all patients undergoing breast mastectomy and TE placement in the prepectoral plane over a 21-month period (169 patients, 267 breasts), comparing AeroForm expanders (n=57) to traditional TEs (n=210). 100% of individuals received acellular dermal matrix. Primary outcomes recorded consisted of postoperative complications, time to second stage reconstruction, and number of post-operative clinic visits.
RESULTS: The AeroForm group had a shorter period to second stage reconstruction than the TE group (135.4 versus 181.7 days; p=0.01) and required fewer clinic visits (5.1 versus 6.9; p<0.01). Partial thickness (25.6% versus 12.3%, p=0.03) and full thickness (8.7% versus 0.0%, p=0.02) necrosis was more common in the saline tissue expander cohort. The rates of infection, hematoma, and seroma requiring drainage were not statistically significant between the two groups.
CONCLUSIONS: Two-staged breast reconstruction with the use of AeroForm expanders in the prepectoral space marks potential progress in improving care for breast cancer patients by demonstrating a reduction in some adverse events, the number of clinic visits, and the time to second stage reconstruction. Future research is indicated with larger cohorts to more accurately assess if there is a difference in tissue necrosis and infection rates between saline and Aeroform tissue expanders, respectively. In order to justify one device over the other these outcomes will need to be further analyzed and evaluated
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