Finding the Right Fill: Determining the Ideal Tissue Expander Fill in Immediate Pre-Pectoral Breast Reconstruction
Kshipra Hemal*, Carter J. Boyd, Sofia Perez Otero, Raessa Kabir, Oriana Cohen, Vishal Thanik, Jamie P. Levine, Nolan S. Karp, Mihye Choi
Plastic Surgery, NYU Langone Health, New York, NY
This study assesses the impact of intraoperative tissue expander (TE) fill on postoperative complications in prepectoral breast reconstruction and posits the optimal fill.
All consecutive, prepectoral TE reconstructions performed between 03/2017 - 07/2022 at a single center were reviewed. A ratio of intraoperative TE fill to mastectomy weight (TEF/MW) was constructed to quantify "deadspace" in the breast pocket, with values closer to 1 signifying less deadspace. Major complications include complications requiring readmission or reoperation. p<0.05 was considered statistically significant.
A total of 184 patients (292 breasts) with average follow up of 27 months were included. Patients were on average 53 years old, non-smoker (99%), non-diabetic (91%), and had a body mass index of 28. All reconstructions were performed immediately following prophylactic mastectomies in 33% and therapeutic mastectomies in 67% of cases. Seventy-one (24%) breasts were radiated, and 89 (48%) patients received chemotherapy. Median mastectomy weight was 551 grams, average intraoperative TE fill was 194 163 cc, and average final TE fill was 416 159 cc.
Major complications occurred in 61 (21%) breasts and were associated with higher intraoperative TE fill (277 cc vs. 174 cc, p <0.001) and less deadspace (0.49 vs. 0.37, p <0.05). In multivariable models, higher TE fill was associated with major complications: for every 10 cc increase in intraoperative TE fill, the odds increased by 1.03 (95% CI [1.01-1.05], p=0.002). Optimal intraoperative TE fill for avoiding major complications was 80 cc and optimal ratio was 0.09.
Among major complications, explantation occurred in 44 (15%) breasts; the optimal intraoperative TE fill for avoiding explantation was 80 cc and optimal ratio was 0.12.
Higher intraoperative TE fill and less deadspace was associated with major postoperative complications, explantation, and need for TE exchange. Filling a TE to 80 cc or approximately a tenth of mastectomy weight may help in avoiding complications.
Back to 2023 Abstracts