LAUSR

INTRODUCTION Staged implant-based breast reconstruction with immediate tissue expanders is the most common method of breast reconstruction after mastectomy. Tissue expanders traditionally are filled with saline for expansion. Some surgeons have advocated initial intraoperative fill of the tissue expander with air to avoid excess pressure on ischemic mastectomy skin flaps. The purpose of the study was to compare intraoperative air versus saline tissue fills. METHODS All patients who underwent prepectoral tissue expander reconstruction after mastectomy from 2017-2019 were reviewed. The primary predictive variable was whether saline or air used for initial tissue expansion. Outcome variables included mastectomy skin necrosis, nipple necrosis, infection, number of expansions, hematoma, and explant. RESULTS A total of 53 patients(88 tissue expanders) were included in the study: 28 patients(44 tissue expanders) who underwent initial intraoperative fill with air and 25 patients(44 tissue expanders) who underwent an initial saline fill were assessed. There were no significant differences in complication rates between initial TE fill with saline versus air including nipple necrosis, wound dehiscence, cellulitis, abscess, or TE removal(p=1.0). The number of postoperative tissue expander fills in the initial air fill group was 3.2 compared to 2.7 in the initial saline fill(p=0.27). CONCLUSIONS Prepectoral tissue expander initial fill with air has similar postoperative outcomes compared to initial saline fill. We found no benefit to initially filling prepectoral tissue expanders with air intraoperatively. Given the additional effort of exchanging air for saline during the first postoperative fill, there was no clinical advantage of filling prepectoral tissue expanders with air.