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To Dive or Not to Dive: The Use of Hyperbaric Oxygen Therapy in Immediate Tissue Expander Based Breast Reconstruction
Katherine Zhu
*, Matthew J. Heron, RAFAEL FELIX P. TIONGCO, Arushi Biswas, Aidan Weitzner, Olga Duclos, Rena Atayeva, Carisa Cooney, Damon Cooney, Kristen P. Broderick
Johns Hopkins University School of Medicine, Baltimore, MD
BackgroundPrepectoral tissue expander (TE) based breast reconstruction is an innovative modality, but it may not have the same the perfusion benefit of the pectoralis major muscle adjacent to the skin as subpectoral TE reconstruction. As a result, there may be a higher risk of mastectomy skin ischemia. Hyperbaric oxygen therapy (HBOT) has been shown to salvage compromised mastectomy skin. We analyzed the reconstructive outcomes of patients undergoing TE placement and HBOT at our institution.
MethodsWe retrospectively reviewed patients undergoing immediate TE breast reconstruction from 7/2016 through 1/2022. Demographics, intraoperative data, receipt of HBOT, complications, and final breast reconstruction type were collected. Chi-squared tests determined associations between receipt of HBOT and TE plane.
Results We included 348 patients (552 breasts) undergoing immediate TE breast reconstruction. The distribution of TE placement was 86% prepectoral (299 patients, 477 breasts) and 14% subpectoral (49 patients, 75 breasts). More prepectoral (n=19, 33 breasts vs. n=0) patients received HBOT (p=0.03). For patients who received HBOT, concern for mastectomy skin necrosis was noted on average 7 days after surgery (SD: 4.8 days) and HBOT was started on average 10 days after surgery (SD: 7.7 days). HBOT significantly salvaged more mastectomy pockets, preventing a return to the operating room for TE explantation in 76% (n=25/33) of breasts, compared to 52% (n=17/33) who had mastectomy skin necrosis but did not receive HBOT (p=0.03). For patients who had successful mastectomy pocket salvage after HBOT, the distribution of final reconstructive outcomes was not significantly different than those who did not receive HBOT and did not have TE explantation (p=0.09).
ConclusionsOur study demonstrated that when mastectomy skin necrosis occurs, HBOT can significantly salvage more mastectomy pockets. This data may improve the conversation between patients and surgeons regarding the potential benefits of HBOT for compromised mastectomy skin pockets.
Survival Curve of Mastectomy Skin Pocket Survival by HBOT Status over the 90 Day Post-Operative Period
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