NESPS - Effect of Operative Plane on Anesthetic Requirements in Tissue Expander Breast Reconstruction Patients

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Effect of Operative Plane on Anesthetic Requirements in Tissue Expander Breast Reconstruction Patients
Christina S. Chopra^*^¹, Jason W. Chen^², Syed Shah^³, Tara L. Huston^¹
^¹Plastic Surgery, NUMC/ Stony Brook, Uniondale, NY; ^²School of Medicine, Stony Brook University, Stony Brook, NY; ^³Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY

Background
Initially subpectoral, the plane of choice for tissue expander placement in breast reconstruction has evolved over the past decade, with more surgeons moving to pre-pectoral placement. In making this transition, our institution noted a subjective decrease in the anesthetic requirements of patients undergoing the second stage of their pre-pectoral reconstruction. Despite this, there is little published literature on the topic. Therefore, our study aims to examine the differences in anesthetic requirements among patients with sub-pectoral versus pre-pectoral expanders at the time of exchange to permanent implants.

Methods
We conducted a single-surgeon retrospective chart review of all patients undergoing breast reconstruction with tissue expanders from 2017 to 2024. We compared patients with pre-pectoral to those with sub-pectoral tissue expanders. Variables collected included perioperative pain medications, sedatives, muscle relaxers, antiemetics, reversal agents, and local anesthetics. Additional data were collected on steroids, DM II, and HTN medications and antibiotics used.

Results
52 patients met criteria for evaluation, 26 sub-pectoral and 26 pre-pectoral. We found that sub-pectoral patients averaged a statistically significantly higher requirement of fentanyl and hydromorphone in the perioperative period. This group also had a significantly higher requirement of supplementary antiemetic medications. Other medications including those to manage infection, blood pressure, secretions, deep sedation, and awakening did not vary between groups.

Conclusions
We found patients with pre-pectoral tissue expanders undergoing exchange to permanent implants have decreased perioperative requirements of pain and antiemetic medications. While the operative plane of choice in breast reconstruction is a multifaceted decision, we demonstrate a quantifiable benefit in the prepectoral pain from a perioperative medication perspective. Our study is the first to quantify these differences, and we hope this data will promote evidence-based decisions for patients and physicians.

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